Active Surveillance for Prostate Cancer

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Treatment Overview

Active surveillance is an option for some men who have localized prostate cancer. Localized prostate cancer means that the cancer hasn't spread outside the prostate. For men with low-risk cancer and for some men with medium-risk cancer, choosing active surveillance means that you may be able to avoid or delay treatments like surgery or radiation.

Whether active surveillance is a good choice for you is something you will want to discuss with your doctor. Together you and your doctor will want to consider:

  • Your life expectancy.
  • The stage and Gleason score of your cancer.
  • Your general health.
  • The possible side effects you might have from other treatments.

Your personal preference needs to be part of this decision.

With active surveillance, you and your doctor will watch your cancer closely to see if it appears to be growing. During this time, you will have checkups and tests, such as PSA tests, digital rectal exams, and prostate biopsies.

It may seem odd to have cancer and not have surgery to remove it or radiation therapy to kill the cancer. But unlike many other cancers, most prostate cancer grows very slowly. Slow-growing prostate cancer does not normally cause symptoms. So it is possible to have prostate cancer for years without ever knowing it.

Prostate cancer treatments like surgery and radiation have serious side effects. These side effects include bladder, bowel, and erection problems. With active surveillance, men can wait to start other treatment. Some men will never need more treatment. And others can delay having treatment until tests show their cancer is growing more quickly.

If you choose active surveillance, you are taking a chance that your cancer will grow. But regular checkups will show if this happens. And if it does happen, your cancer still can be treated in the early stages, when treatments are more successful.

If active surveillance is not an option for you, your doctor probably will recommend surgery or radiation. Each type of prostate cancer treatment has its pros and cons. And it is important that you and your doctor think about both when making your treatment decisions.

What To Expect After Treatment

Active surveillance sometimes continues for years. In other cases, tests eventually show that the cancer is growing and needs to be treated.

Why It Is Done

Prostate cancer is typically a slow-growing cancer. Although 16 out of 100 men in the United States will get prostate cancer, only about 3 of these 16 will die of prostate cancer. That means that about 97 out of 100 men will die of something other than prostate cancer.footnote 1

If your cancer is a low-risk cancer or a medium-risk cancer, active surveillance may be an option for you. With active surveillance, men can wait to start treatment. Some men will never need treatment. And others can delay treatment until tests show their cancer is growing more quickly.

How Well It Works

Men who choose active surveillance have a very low risk of dying from prostate cancer. Right now there isn't strong evidence to show which treatment—active surveillance, surgery, or radiation—provides the best long-term survival in men who have localized cancer. But a study is currently being done to compare the treatments.footnote 2

Risks

There is a chance that your prostate cancer will grow during active surveillance. If this happens, your doctor will recommend other treatment, such as surgery or radiation.

If you choose active surveillance, it's very important to follow your doctor's schedule of tests and exams. Regular checkups will increase your chances of finding out right away if your prostate cancer grows. That way your cancer still can be treated in the early stages, when treatments are more successful.

What To Think About

If you choose active surveillance, you can change your mind at any time and have surgery or radiation, even if tests show that your prostate cancer hasn't changed.

Men who older than 80 and men who have other serious medical conditions and aren't well enough to have surgery or radiation often choose watchful waiting. Watchful waiting means that you'll still be under the care of your doctor. But the goal of watchful waiting is to only treat symptoms that bother you. (For active surveillance, the goal is to cure the cancer if tests show that the cancer is growing.)

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

References

Citations

  1. Scher HI, et al. (2015). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 932–980. Philadelphia: Walters Kluwer.
  2. Lane JA, et al. (2014). Active monitoring, radical prostatectomy, or radiotherapy for localised prostate cancer: Study design and diagnostic and baseline results of the ProtecT randomised phase 3 trial. Lancet Oncology, (10): 1109–1118. DOI: 10.1016/S1470-2045(14)70361-4. Accessed August 14, 2015.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology

Current as ofJuly 26, 2016