When you learn you have prostate cancer, your first thought is likely to be, “How soon can I start treatment?” But if your tumor is small, slow-growing, and not likely to spread to other parts of your body, your doctor may offer you the choice to watch your cancer closely and delay treatment until it starts to grow. This treatment option is called active surveillance.
Doctors used to think that all tumors grew quickly and that treatment should always start as soon as possible. Now we know that’s not the case with prostate cancer.
Some prostate tumors do grow quickly. But others grow very slowly. In fact, some grow so slowly that some men with prostate cancer are more likely to die from another illness, like heart disease, even if they don’t treat their prostate cancer. This is why active surveillance may be an option for some men.
Who Can Get Active Surveillance?
Active surveillance may be an option if your cancer:
- Is small
- Is only in your prostate
- Has a prostate-specific antigen (PSA) level less than 10 ng/mL
- Has a Gleason score of 7 or less, which means your cancer is slow-growing. A pathologist (a doctor who studies cells and tissue) will look closely at your tumor biopsy to get your Gleason score.
- Could be treated with surgery or radiation if it starts to grow
You must also:
- Not have any symptoms
- Feel OK about waiting to see if your cancer grows. (You’re in charge of all your treatment decisions.)
- Be able to go about your day-to-day life and not worry your cancer will spread
- Understand the benefits and risks of your decision to follow active surveillance
What to Consider
Prostate cancer that hasn’t spread to other parts of the body is treated with surgery or radiation. These treatments can cause side effects such as incontinence (not being able to control urine), erectile dysfunction (problems getting or keeping an erection), and bowl problems such as pain, burning, or diarrhea. If you choose active surveillance and your cancer never grows, you would avoid these side effects.
If you choose to start treatment right away, you wouldn’t have to get the regular tests that are part of active surveillance to see if your cancer had grown. You would also have to learn how to manage your treatment’s side effects.
How It Works
Active surveillance keeps a close watch on your tumor to see if it starts to grow. If you choose active surveillance, your doctor will tell you what tests you need and how often you need to have them. It’s very important that you not miss any of these tests.
Many doctors use guidelines from the American Society of Clinical Oncology. They recommend:
- A prostate-specific antigen (PSA) blood test every 3 to 6 months to see if your PSA level has gone up, which could mean that your cancer has grown
- A digital rectal exam (DRE) at least once a year so your doctor can feel for new bumps or hard spots on your prostate
- A follow-up biopsy 6 to 12 months after your prostate cancer diagnosis to check on the tumor’s growth
- A biopsy every 2 to 5 years to see if the cancer cells have started to grow more quickly
If your doctor sees signs that your tumor has grown, they will talk to you about whether it’s time to stop active surveillance and start treatment.
Is Watchful Waiting the Same as Active Surveillance?
Some people use the term “watchful waiting” when talking about active surveillance, but they are not the same thing.
Doctors usually recommend watchful waiting for patients who are older or who have other serious health problems. With watchful waiting, there are fewer tests. Instead, your doctor will watch to see if you get any prostate cancer symptoms. If you do, you and your doctor will talk about next steps. This could be treatments for the cancer. Or it could be treatments that will control the symptoms. The decision will be based on your age and other health problems.
Some doctors may use the term watchful waiting to describe an approach other doctors might call active surveillance. Be sure to ask your doctor what they mean by watchful waiting or active surveillance.
What Research Shows
Only a few studies have compared active surveillance to treatment. These studies have found that men with slow-growing tumors who choose active surveillance are likely to live as long after their prostate cancer diagnosis as men with slow-growing tumors who have surgery or radiation right away.
Making Your Decision
Some men prefer to have regular tests to see if their cancer starts to grow than to start treatment right away. They don’t feel like they will worry about it all the time that their cancer has grown. And they want to try to avoid treatment-related side effects, if they can.
On the other hand, some men don’t want to live with a cancer that might be growing, and they want to start treatment right away. They feel they would worry too much if they didn’t start treatment. And they don’t want to have to go to the doctor for regular tests.
You’ll want to weigh the pros and cons and see what you’re most comfortable with. There is no “right” way to think about these choices. The best choice is the one that is right for you. And no matter what approach you take, you’re in charge of your treatment decisions.