Active Surveillance for Prostate Cancer

When you find out that you have prostate cancer, your natural reaction may be to want to get the cancerous tissue out right away. It’s a completely understandable — and normal — response. But not all prostate cancers are alike, and not all of them are equally aggressive or likely to spread. Sometimes, the best approach is just keeping a watchful eye on the disease, a strategy known as active surveillance. We may recommend active surveillance if you have:

  • a small tumor that’s limited to the prostate
  • a slow-growing cancer
  • a low risk that the cancer will grow locally or spread (metastasize) or that you’ll die from the disease

Active surveillance is being selected more frequently as the treatment option of choice by men with low-risk prostate cancers. While the word “cancer” is generally considered ominous, many men with prostate cancer do not benefit from immediate treatment. It’s a very personal decision, and we’re here to help you consider all your options and address your questions and concerns.

What Happens during Active Surveillance

Active surveillance is a form of treatment. It’s not the same as receiving no treatment at all. With this method, we put off treatments, such as surgery and radiation therapy, because tests indicate that the tumor is currently not life threatening or is at a low risk of spreading or getting worse.

Your doctors team up to monitor your tumor for any signs that it may be changing and reevaluate your treatment if the cancer becomes more active. For example, if your Gleason score or prostate-specific antigen (PSA) level start to rise, we may recommend stopping active surveillance and starting another type of treatment.

The key to making sure that active surveillance is the appropriate treatment approach for you is determining as certainly as possible that the disease is confined to the prostate and does not have aggressive features. To do this, we may want you to have additional testing.


Prostate MRI provides the best “look” at the entire prostate and can identify areas of concern within the gland that might not have been sampled during the initial biopsy procedure. For some men, we may recommend a second prostate biopsy to better determine risk. We may also do genetic studies of your biopsy material to determine whether active surveillance is an appropriate management strategy. By combining several tests, we can assess the risk that your tumor will grow.


The advantage of active surveillance for men with localized, early-stage prostate cancer is that they can be spared the potential side effects of surgery and radiation therapy, such as urinary incontinence (the inability to hold in urine), rectal bleeding, and erectile dysfunction.