Not all prostate cancers are the same. Some grow quickly and need treatment right away. Others grow slowly and are less likely to metastasize (spread) to other parts of your body. This kind of prostate cancer is low risk.
If you have a prostate cancer that grows slowly, your healthcare provider may recommend active surveillance, also called “watchful waiting” or “active monitoring.”
Sometimes, the best approach is to just keep monitoring (watching) your prostate cancer. This method is called active surveillance.
What is prostate cancer active surveillance?
Active surveillance is a form of treatment for prostate cancer. It’s not the same as having no treatment.
This treatment option helps people with slow-growing prostate cancer avoid possible side effects of surgery and radiation therapy, including:
- Urinary incontinence (trouble holding in your pee)
- Rectal bleeding
- Erectile dysfunction (it’s hard to get or keep an erection)
During active surveillance, your care team will monitor your prostate cancer closely.
Your care team will include a urologist (a doctor with special training in the urinary system) and an advanced practice provider (APP). Your APP will be a nurse practitioner (NP) or physician assistant (PA) with education and training in prostate cancer. They will work with your urologist to treat your cancer.
You may decide to enroll in active surveillance after your first visit with your urologist. You can then schedule your regular follow-up appointments with your urologist or an active surveillance APP.
As part of active surveillance, you will have tests every few months to watch for any changes in your prostate. For more information about the schedule for testing, see “Active surveillance schedule.”
Your care team may notice changes in your prostate or tumor at any time during surveillance. If so, they may recommend you stop active surveillance. You may start another type of treatment, such as surgery or radiation therapy.
Active Surveillance APPs
Nurse Practitioner
When to choose prostate cancer active surveillance
Your healthcare provider may recommend active surveillance if you have:
- A small tumor that’s only in your prostate.
- Cancer that grows slowly.
- A low risk the cancer will grow or spread.
- A tumor that does not threaten your life.
You may also have genetic testing. Your care team will use the results from these tests to see if active surveillance is the right treatment for you.
Active surveillance can be the right choice for people with low-risk prostate cancers. It’s a treatment option that matches how harmful the cancer is. Treatment for cancer is a very personal decision. MSK experts are here to help you consider all options and answer your questions.
What does prostate cancer active surveillance involve?
There are 4 parts to active surveillance monitoring:
- A prostate biopsy.
- Prostate magnetic resonance imaging (MRI).
- Prostate-specific antigen (PSA) blood testing.
- A digital rectal exam (DRE).
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 take pictures of the inside of your body. It’s used to see the type, size, and location of tumors.
A prostate MRI gives us the best picture of your entire prostate. It can help your healthcare provider see areas of the gland that could be cancer 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 during 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) as part of your regular surveillance visits. Your healthcare provider will put a gloved finger into your rectum (the bottom section of your colon).
They will examine the end of your prostate for any nodules. These are abnormal growths of tissue that may or may not be cancer.
Your healthcare provider will compare these results to the DREs you had before. A change in your DRE from one exam to the next could be a sign of a change in your cancer. It’s a useful tool for helping your care team choose the next steps in active surveillance.
Your care team will review the results from all of these tests. They will see if active surveillance is still the best treatment plan for you.
What to expect during active surveillance
You and your urologist may decide active surveillance is right for you. If so, you will be enrolled in the active surveillance program to closely monitor your cancer.
You will have regular follow-up appointments when you’re in the active surveillance program. They may be scheduled with your urologist or with an active surveillance APP. Learn more about the “Active Surveillance Schedule.”
Your first prostate cancer active surveillance appointment
At your first appointment, you will meet with your urologist to review your test results. You may have had tests done by a different healthcare provider or hospital than Memorial Sloan Kettering (MSK). If so, it’s very helpful if you get us your results to review. Before your appointment, please send us your radiology disks, pathology slides, and copies of your laboratory test results.
During your first appointment, you may also meet the rest of your care team, including your active surveillance APP and nurses.
Your urologist may not be at all your follow-up appointments. Most of your visits will be with an active surveillance APP. They will continue to work closely with your urologist to manage your prostate cancer. Your healthcare provider will review your active surveillance schedule with you at each visit.
Active surveillance for prostate cancer schedule
Here is an example of what your active surveillance schedule may look like. More appointments will be scheduled for you, depending on your test results.
| Appointment | What to expect |
|---|---|
| Your first appointment |
|
| 3 to 6 months after your first appointment |
|
| 6 months after your first appointment |
|
| Every 6 months |
|
| Every 18 months |
|
| Every 3 years |
|
*If your PSA is higher than your previous PSA results, you may be required to repeat your PSA 6 to 8 weeks later.
** You may have a change in your PSA results over time, or your MRI may look suspicious (unusual). If so, your care team may decide to move up your MRI, your surveillance biopsy, or both.
Telemedicine visits
MSK also has telemedicine visits available for people undergoing prostate cancer active surveillance or monitoring. Telemedicine visits connect you to your healthcare provider through your computer or smart device (smartphone or tablet). If you want to learn more, read Telemedicine Visits at MSK.
If you’re having a telemedicine visit, we’ll schedule a separate lab appointment. You will have your blood drawn at an MSK location before your telemedicine visits. Your healthcare provider will review your symptoms, your health status, and PSA results.
Emotional effects of active surveillance
People who choose active surveillance for prostate cancer may feel nervous at some point. You may have these feelings before your appointments, after a test, or when your test results show something new. You may worry your prostate cancer is growing, without you knowing.
It’s important to remember that the chances of this happening are really low. That’s because your care team will be looking for important changes to your prostate. They will be monitoring the cancer very closely.
MSK can help you cope with your feelings. 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 getting treatment for prostate cancer.
You can explain to them that you have a slow-growing type of cancer. It does not need more traditional forms of cancer treatment, such as surgery. It’s also important to explain to them that active surveillance is a form of treatment. It’s been shown to be very good for managing the kind of prostate cancer you have.
