Active surveillance is an option for men who have low-risk localized prostate cancer. Low-risk cancer means the cancer isn't likely to grow right away. And localized prostate cancer means the cancer hasn't spread outside the prostate. 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 who have low-risk prostate cancer 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 your localized prostate cancer is not low-risk, 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.1
If your cancer is caught before it has spread and it is a low-risk cancer, you may choose active surveillance rather than surgery or radiation. With active surveillance, men who have low-risk prostate cancer 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 have newly diagnosed, low-risk localized prostate cancer may choose to take a little time to make their decision about treatment.
Men with low-risk localized prostate cancer 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 low-risk cancer. But a study is currently being done to compare the treatments.2
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.)
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.
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.
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerChristopher G. Wood, MD, FACS - Urology, Oncology
Current as ofNovember 20, 2015