Active Surveillance for Prostate Cancer

This information explains a treatment for prostate cancer called active surveillance.

Not all prostate cancers are the same. Some may grow quickly, while others grow slowly and are less likely to spread to other parts of your body (metastasize). If you have a slow-growing, low risk prostate cancer, your healthcare provider may recommend active surveillance for your prostate cancer treatment.

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About Active Surveillance

Active surveillance is a form of treatment for prostate cancer. It’s not the same as receiving no treatment.

This treatment option helps men with slow-growing prostate cancer avoid the possible side effects of surgery and radiation therapy. Side effects include urinary incontinence (trouble holding in your urine), rectal bleeding, and erectile dysfunction (difficulty getting or keeping an erection).

During active surveillance, your healthcare team will monitor your prostate cancer closely. Your healthcare team will consist oF a urologist and an advanced practice provider (APP). Your APP will be a nurse practitioner (NP) or physician assistant (PA) that has education and training in prostate cancer and will work with your urologist to treat your cancer. If you decide to enroll in active surveillance after your first visit with your urologist, you can schedule your regular follow up appointments with your urologist or an active surveillance APP.

As part of active surveillance, you’ll have tests every few months to watch for any changes in your prostate. For more information about the schedule for testing, see the section called “Active surveillance schedule.”

If your healthcare team notices any changes in your prostate or tumor at any time during surveillance, they may recommend stopping active surveillance. You may start another type of treatment, such as surgery or radiation therapy.

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When to Choose Active Surveillance

Your healthcare provideR may recommend active surveillance if you have:

  • A small tumor that’s only in your prostate

  • A slow-growing cancer

  • A low risk that the cancer will grow or spread

  • A tumor that isn’t life threatening

There a four main components to active surveillance monitoring which include prostate biopsy, prostate magnetic resonance imaging (MRI), prostate-specific antigen (PSA) blood testing, and digital rectal exam (DRE). You may also have genetic testing.

Your healthcare team will use the results from all of these tests to see if active surveillance is the right treatment option for you.

Prostate biopsy

During a prostate biopsy, small samples of tissue are taken from your prostate gland. The samples are examined under a microscope, checked for signs of cancer, and given a Gleason score. A Gleason score lets your healthcare provider know how likely it is that your cancer will spread.

Prostate MRI

An MRI uses strong magnetic fields to produce pictures of the inside of your body. It’s used to see the type, size, and location of tumors. A prostate MRI provides the best look at your entire prostate and can help your healthcare provider see areas of the gland that look suspicious and may need to be biopsied. Your MRI may also show some changes to your prostate over time. This is normal. Your healthcare provider will look for any major changes in your routine surveillance MRI. Depending on your results, they may ask you to have an early prostate biopsy.

 

Prostate-specific antigen (PSA) blood test

You will have regular PSA blood testing done. PSA is a normal protein made by your prostate gland. PSA blood tests are done to check your levels to see if your cancer is growing or changing. Your PSA levels will go up and down during active surveillance. This is normal. Your healthcare provider will monitor your levels and look for major changes over time.

Digital rectal exam (DRE)

You will also have a digital rectal exam (DRE) done as part of your regular surveillance visits. Your healthcare provider will insert a gloved finger into your rectum (the bottom section of your colon) to examine the end of your prostate for any nodules (abnormal growths of tissue that may or may not be cancer). Your healthcare provider will compare these results to your previous DRE. A change in your DRE from one exam to the next could be a sign of a change in your cancer and is a useful tool in directing next steps in active surveillance.

Your healthcare team will review the results from all of these tests to see if active surveillance continues to be the best treatment option for your prostate cancer.

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What to Expect During Active Surveillance

If you and your urologist decide that active surveillance is right for you, you will be enrolled in the active surveillance program to closely monitor your cancer. The active surveillance program requires regular follow-up appointments which may be scheduled with your urologist or with an active surveillance APP. For more information about your schedule, see the section called “Active Surveillance Schedule.”

At your first appointment, you will meet with your urologist to review your test results. If you have tests done by a healthcare provider or hospital outside of MSK, it’s very helpful to send your radiology disks, pathology slides, and copies of your laboratory test results to your healthcare provider at Memorial Sloan Kettering (MSK) to review before your appointment.

During your first appointment, you may also have the opportunity to meet the rest of your healthcare team, including your active surveillance APP and nurses.

Your urologist may not be at all your follow-up appointments, most of which will take place with an active surveillance APP. Your active surveillance APP will continue to work closely with your urologist managing your prostate cancer. Your healthcare provider will make sure to review your active surveillance schedule with you at each visit

 

Active surveillance schedule

Here is an example of what your active surveillance schedule may look like. Additional appointments will be scheduled for you depending on your test results.

Appointment What to expect
Your first appointment
  • Review your test results and medical history

  • Have a physical exam 

  • Meet your healthcare team 

3 to 6 months after your first appointment
  • Additional testing

If you need to have an MRI done, wait 3 months after your first prostate biopsy so that your prostate can heal. You may also need to have a repeat or confirmatory biopsy which helps support the decision to start active surveillance

6 months after your first appointment
  • You will find out if you’re eligible for the active surveillance program. 

  • If you’re eligible, your follow-up appointments will be scheduled for you. You will have a PSA blood test and a physical exam every 6 months.

Every 6 months
  • PSA blood test*
  • Physical exam
Every 18 months
  • Prostate MRI**
Every 3 years
  • Prostate biopsy**

*If your PSA is higher than your previous PSA results, you may be required to repeat your PSA in 6 to 8 weeks later. 

** If there is a change in your PSA results over time or your MRI appears suspicious, your healthcare team may decide to move up your MRI and/or surveillance biopsy 

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Telemedicine Visits

At MSK, we also have telemedicine visits available. Telemedicine visits connect you to your healthcare provider through your computer or smart device (smartphone or tablet). If you’d like to learn more about telemedicine visits at MSK, read Telemedicine Visits at MSK

If you’re scheduled for a telemedicine visits, we’ll schedule a separate lab appointment to have your blood drawn (lab appointment) at an MSK facility before your telemedicine visits. Your healthcare provider will review your symptoms, your health status, and PSA results.

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Emotional Effects of Active Surveillance

Men who choose active surveillance may feel nervous at some point. These feelings may come about before your appointments, after having a test done, or when your test results show something new. You may worry that your cancer is growing without you knowing. However, it’s important to remember that this is unlikely to happen. Your healthcare team will be looking for important changes to your prostate and will be monitoring your cancer closely.

Help is available for you at any time. If you would like counseling, your healthcare provider can give you a referral to see a social worker, psychiatrist, or counselor.

Your family and friends may not understand why you’re not receiving treatment for prostate cancer. You can explain to them that you have a slow-growing type of cancer that doesn’t need to be treated with more traditional forms of cancer treatment, such as surgery. Also, it’s important to explain to them that active surveillance is a form of treatment and has been shown to be very effective to manage prostate cancers like yours.

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