About this page. This is a plain English summary of active surveillance. It does not replace medical advice from your own doctor or specialist.
For full information and references, please read the detailed page.
What is active surveillance?
Active surveillance is a way of managing prostate cancer that does not involve surgery or radiotherapy straight away. Instead, the cancer is watched very closely, and treatment is started only if and when the cancer changes.
The important word is active. This is not the same as "wait and watch" - that means leaving the cancer alone with no follow-up. Active surveillance is a careful, planned monitoring program with the option to step in and treat if needed.
Why might someone choose active surveillance?
Many prostate cancers, especially when they are caught early and look low-grade on the biopsy, grow very slowly. For some men, especially older men or men whose cancer is small and low-grade, treatment can do more harm than the cancer itself.
Active surveillance lets these men keep their normal quality of life and avoid the side effects of surgery and radiotherapy, while still being monitored carefully.
Who is suited to it?
Each case is individual, but in general the ideal candidate for active surveillance has:
- A PSA of less than 10.
- A Gleason score of 6 or below.
- Fewer than three biopsy cores positive for cancer.
- A PSA that is stable rather than rising quickly.
Older men are particularly well suited, but it can also be a sensible choice for younger men who want to preserve their quality of life.
How is it monitored?
- A PSA blood test, usually every three months.
- A repeat biopsy at one year, and then every one to two years after that.
- An MRI scan in some cases, which can sometimes replace a repeat biopsy.
- Regular reviews with the urologist to talk through the trend.
What if the cancer changes?
If the PSA starts to rise more quickly, or a biopsy shows a higher grade, or the patient finds the watching too stressful, the plan changes and active treatment is offered. Studies have reported that around 30 to 40% of men on active surveillance go on to have treatment within five years - either because the cancer has progressed or because of anxiety.
Important things to know
- There is a small chance that the cancer can progress beyond the prostate while on surveillance. This is why monitoring needs to be done properly and on schedule.
- Some men find watching their cancer stressful. The mental side of active surveillance is real and should not be ignored.
- Repeat biopsies, especially over many years, can cause some scarring of the prostate, which may make a later nerve-sparing operation more difficult.
- Active surveillance is not "doing nothing". Skipping appointments or scans defeats the whole point and can be dangerous.
- Active surveillance is not suitable for everyone. It is offered after a careful look at the PSA, Gleason score, scans, and the man's general health and preference.
What you can do next
- Read the full detailed page with references and the BAUS active surveillance brochure.
- Short version overview of prostate cancer.
- Short version: treatment options, if active surveillance is not the right fit.
- Short version: dealing with a new diagnosis.
- Request a second opinion on a surveillance plan.
- Call 02 8382 6980 to make an appointment.