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.
MSK’s Prostate Active Surveillance care team is led by advanced practice providers (APPs) Kenny Lin and Natalie Wolchasty, along with Dr. Behfar Ehdaie, a urologic surgeon. Active surveillance care is also available at some of our regional locations – a care coordinator can help find the most convenient location for you.
You may decide to enroll in active surveillance after your first visit with your urologist. You can then start the program by scheduling your first appointment with an active surveillance APP.
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)
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, take a look at the “Active surveillance schedule” below.
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.
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 that 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?
During active surveillance, you’ll have tests every few months to look for any changes in your prostate. You will also have regular follow-up appointments with your active surveillance APP. Genetic or genomic testing may be suggested when appropriate. Your care team will use the results from these tests to monitor the cancer.
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)
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 Type||When||What to Expect|
|Welcome Visit||When you first start Active Surveillance at MSK||This is your first visit in the program. Meet your advanced practice provider (APP) and learn about the program.|
|PSA Blood Test and APP Visit||Every 6 months*||Get a PSA blood test. Visit with your APP to talk about your results and health.|
|Prostate MRI||Every 18 months**||Get a prostate MRI.|
|Prostate Biopsy||Every 3 years||Get a prostate biopsy.|
*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.
About the Treatments
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.
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.
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.
Care at your convenience
Our program offers care wherever you are.
Every 6 months, you’ll have a visit with your APP. These will alternate between telemedicine and in person. Telemedicine visits connect you to your healthcare provider through your computer or smart device (smartphone or tablet).
Local PSA Testing
MSK has locations in New York and New Jersey. You can have your PSA blood tests every 6 months at a location that’s easiest for you. To schedule your next PSA test at an MSK regional site, talk with your care coordinator or office coordinator.
During Prostate Active Surveillance, you may be referred to one or more programs that can help you manage your symptoms and the emotional and financial impact of cancer treatment.
If the cancer grows or spreads, will active surveillance catch it early enough for treatment?
Yes. We understand you may be worried about living with cancer, afraid it’s growing without you knowing. It’s important to remember this is unlikely to happen. Research shows that active surveillance is a safe treatment for people with low-risk cancers. Whether you choose active surveillance or more aggressive treatment, your risk of dying from prostate cancer is just as low. Your care team monitors the cancer closely. They look for important changes to your prostate. If the cancer grows or spreads, your care team will know in time to take action.
Are active surveillance screenings like MRIs and biopsies accurate at catching cancer growth?
Yes. We cannot predict who will have cancer that gets worse or needs treatment in the future. But we know it’s unlikely we will miss a change in the cancer if you follow your active surveillance schedule. The usual schedule is a PSA test every 6 months, MRIs every 18 months, and surveillance biopsies every 3 years. We may change this protocol if we see anything different in your PSA or MRI results. This is how we find cancer that’s growing.
People in my life are asking me why I did not get the cancer removed. What should I say?
Your family, friends, or even other doctors may not understand why you’re not getting treatment. You can tell them you have a kind of cancer that grows slowly. It does not need usual kinds of cancer treatment, such as surgery. It’s also important to explain that active surveillance is a form of treatment. Research shows it’s very good for managing the kind of prostate cancer you have.
Does it mean the cancer is growing or spreading if I have symptoms, such as trouble urinating (peeing)?
No. It’s normal to have some lower urinary symptoms as you age. They are not a sign of cancer. More often, they are signs of benign prostatic hyperplasia, or BPH. It’s caused by an enlarged (bigger) prostate and is not cancer. Symptoms include leaking urine, urinating often, and being unable to empty your bladder all the way. Treatments can help with these symptoms. Please contact your MSK health care provider to discuss your symptoms. We can help or refer you to a special MSK clinic.
My PSA level looks high or keeps changing. Should I worry?
There’s no normal PSA level, only a level that’s normal for you. We find out that level by testing you every 6 months. It’s also very normal for your PSA level to change. It can vary from test to test, or even day to day, by as much as 50%. A spike or change in your PSA most often is caused by inflammation (swelling), not cancer. If there’s a big change, we will repeat the test in 6 to 8 weeks. The repeated test often is closer to your normal range. If your PSA rises slowly after many tests, we will decide if you need an early MRI to learn more.
Sometimes I feel nervous about my decision to do active surveillance instead of other treatments. Should I change my mind?
Many people who choose active surveillance feel nervous at some point. Often, they have feelings before appointments, after a test, or when test results show something new. It’s normal to worry with active surveillance. Research shows this feeling goes away soon. Within 2 years of starting active surveillance, most people do not feel more anxious than usual. It may also help to know you’re not alone. At MSK, more than 9 out of every 10 people with low-risk cancers (92%) choose active surveillance. Many people feel that living with cancer gets much easier over time. MSK is here to help if you would like counseling at any time. Your care team can give you a referral to see a social worker, psychiatrist, or counselor.