Active surveillance of prostate cancer

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Treatments for prostate cancer often cause side-effects that can affect your quality of life. 

Active surveillance means monitoring your condition closely with tests like blood tests and scans so you can avoid or delay unnecessary treatment. 

You can start treatment to cure your cancer as soon as you need it, but you may not need treatment for many years, if at all.  

Who can have active surveillance?

If you have prostate cancer that is seen as low risk, you may be suitable for active surveillance. If you have a medium-risk prostate cancer, you may be suitable too. It will also depend on your age, the amount of cancer in your biopsy and your general health.

If you have high-risk cancer you will not be suitable for active surveillance, as your doctor will want to start active treatment to get the cancer under control.

What does active surveillance involve?

You’ll have regular tests to check for any changes in your cancer. If any changes are noticed, your doctor will talk to you about the need for treatment. The tests usually include:

• PSA blood tests every few months at the start, and then every 6 months after a couple of years.
• Regular digital rectal exams (where the doctor examines your prostate gland through your rectum (back passage)).
• MRI scans, and possibly a more detailed mpMRI scan.
• Prostate biopsies (taking samples of prostate tissue). You may need one or more biopsies while on active surveillance.

What if my test results change?

Your doctor will talk to you about the need for more tests or treatment if:

• The PSA level rises.
• The MRI scan shows a change in the size or location of your prostate cancer.
• Your doctor feels any changes during the digital rectal exam.
• There’s a change in the amount or the grade of cancer in the repeat biopsy sample.

Advantages and disadvantages of active surveillance

Advantages 

• No treatment-related side-effects, like urinary or sexual side-effects.
• Does not interfere with your everyday life.
• You can avoid unnecessary treatment.

Disadvantages 

• You may feel anxious or worried about your cancer changing.
• Repeat tests and investigations are needed, which can be stressful.
• There is also a small chance that your cancer will be more fast-growing than first thought. A more fast-growing prostate cancer benefits from earlier treatment.
• There is a chance that your cancer will grow while you are on active surveillance. But your tests will help to pick up any changes at an early stage when you can still have successful treatment.

Questions to ask about active surveillance

• How often will I need to have my PSA level checked?  
• Who will check my PSA level and give me the results? 
• How often will I have to go back for check-ups? 
• How often will I have a digital rectal examination?  
• How often will I need repeat MRI scans?
• How often will I need repeat prostate biopsies? 
• How quickly would my PSA level have to rise for treatment to be considered necessary?
• What treatments could I have if my cancer grows?