Prostate Cancer: Active Surveillance

Not every person with prostate cancer needs to be treated right away. In many cases, early-stage prostate cancer will not spread or cause any problems or side effects for a long time, if ever. That’s why your healthcare provider may suggest active surveillance. This is the decision to watch prostate cancer, instead of treating it right away. Treatment can then be done later if the cancer is growing quickly or causing symptoms.

Active surveillance or watchful waiting?

Active surveillance is sometimes also called watchful waiting. And some healthcare providers see these as 2 different things. You may have more exams and tests over time with active surveillance, but fewer with watchful waiting. Your provider will tell you which term they use and what it means for you.

When active surveillance is a choice

Active surveillance may be a choice for you if:

  • Your healthcare provider believes that your cancer is growing slowly

  • You have a tumor that hasn’t spread

  • You have a low Gleason score

  • You’re older and don’t want to risk the side effects that treatments, such as surgery and radiation, may cause

  • You're in poor health or have another serious health problem that makes prostate cancer a lower priority

Who probably should not use active surveillance

Active surveillance may not be a choice for you if:

  • You're younger and have no other health problems

  • Your cancer is growing quickly

  • Your cancer was found early and may be cured

What to expect during active surveillance

You'll likely see your healthcare provider every 3 to 6 months. At each visit, your provider will likely give you a blood test. This is done to test the level of prostate-specific antigen (PSA) in your blood. You may also have a digital rectal exam (DRE). You may also have a prostate biopsy periodically. These tests can show signs that the cancer may be growing. 

If your PSA level starts to go up, your provider will carefully watch how fast it's rising. This rate of change is called the PSA velocity. Based on the results, your provider may advise a prostate biopsy to see if the cancer is growing faster. They may advise other tests as well. Your provider can also help you decide if and when you want to start treatment. For instance, you may decide to start treatment if your PSA reaches a certain level. Or you may start treatment if a biopsy shows the cancer is growing faster.

It's also important to let your provider know about any new symptoms you have. New symptoms may be a sign of the cancer growing. Ask your provider what symptoms to watch out for. And ask which symptoms mean you should call and be examined before your next scheduled appointment. 

Online Medical Reviewer: L Renee Watson MSN RN
Online Medical Reviewer: Rita Sather RN
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 6/1/2021
© 2023 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare provider's instructions.