Active Surveillance for Prostate Cancer
Active surveillance is an established approach for men whose prostate cancer appears unlikely to cause harm in the near future. Instead of immediately having surgery or radiation, the cancer is carefully monitored, with treatment considered if there are signs that it is becoming more aggressive.
Active surveillance is most commonly recommended for men with low-risk prostate cancer, although some men with carefully selected favorable intermediate-risk cancer may also be candidates.
Active surveillance is not the same as ignoring the cancer. Its purpose is to avoid or delay the urinary, sexual, and bowel side effects that can occur with treatment while preserving the opportunity to treat the cancer if necessary.
Who Is a Candidate?
Active surveillance is most appropriate when the cancer appears to have a low likelihood of growing or spreading quickly.
Typical candidates have cancer that is:
Confined to the prostate
Grade Group 1 (Gleason 3 + 3), or sometimes carefully selected Grade Group 2 (Gleason 3 + 4)
Associated with a relatively favorable PSA level and other risk factors
Limited in extent on biopsy and imaging
Age, overall health, family history, MRI findings, and personal preferences can also influence the decision.
The important question is not simply “Do I have prostate cancer?” but “What is the risk that this particular prostate cancer will cause me harm?”
What Does Active Surveillance Involve?
Active surveillance means regularly checking the cancer for signs of change. The exact schedule varies, but monitoring may include:
PSA blood tests at regular intervals
Periodic physical examinations
MRI scans to look for changes in the prostate
Repeat biopsies when appropriate
If the PSA, MRI, biopsy, or other findings suggest that the cancer is becoming more aggressive, treatment with surgery, radiation, or another approach can then be considered.
The goal is to treat only when treatment is necessary, while monitoring closely enough to detect an important change.
Why Choose Active Surveillance?
The major advantage is that a man may be able to avoid or postpone treatment and its possible side effects while the cancer is unlikely to threaten his health.
Surgery and radiation can be very effective, but they may affect urinary control, sexual function, and sometimes bowel function. For a cancer that may never become dangerous, these side effects can have an important impact on quality of life.
Active surveillance also preserves the option of treatment later. If monitoring shows that the cancer is changing, treatment can usually be started at that time.
For appropriately selected men, the goal is not simply to delay treatment. It is to avoid treating a cancer that may never need treatment.
What Are the Risks?
Active surveillance requires regular follow-up. A cancer initially thought to be low risk may later show signs of being more aggressive.
A biopsy also samples only portions of the prostate, so a more aggressive area of cancer can occasionally be missed. MRI, repeat biopsies, and other tests can help reduce this risk.
Some men also find it psychologically difficult to know that they have cancer without immediately treating it.
For these reasons, active surveillance works best when there is a clear monitoring plan and regular follow-up. If evidence shows that the cancer is progressing, treatment can then be considered.
Learn More
An overview of who may be a candidate, how surveillance works, and when treatment may become appropriate.
Videos
PCRI discusses when men with Gleason 3+4=7 prostate cancer may be candidates for active surveillance and when focal therapy or other treatment might be considered.
PCRI discusses active surveillance for selected men with Gleason 3+4 prostate cancer and explains how additional testing and imaging can help determine whether treatment is necessary.