Active Surveillance for Prostate Cancer

Treatment Overview

Most men who are diagnosed with prostate cancer have localized cancer, which means that the cancer hasn't spread outside the prostate. Some men who have localized prostate cancer choose active surveillance, which allows them to avoid or delay having surgery or radiation. Active surveillance is an option for men with cancer that isn't likely to grow.

Tests will show if the cancer is likely to grow. With localized prostate cancer:

• Low-risk cancer isn't likely to grow right away. These men can choose active surveillance. This means their doctors will watch the cancer closely with regular checkups and tests to see if the cancer grows. This choice allows a man to delay having surgery or radiation, often for many years. If the cancer grows very slowly, treatment may never be needed.
• Medium-risk cancer is more likely to grow. Some men with this type of cancer may be able to choose active surveillance. Others may need to choose surgery or radiation.
• High-risk cancer is most likely to grow. Men with high-risk cancer will likely need to choose 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.