Is Active Surveillance Right for You?

As with all treatment decisions, only you and your doctor can decide what’s best for you. If your prostate cancer is “low risk” (early stage cancer that grows slowly and is unlikely to spread) one of the options to consider is called active surveillance. Active surveillance means you’ll continue getting regular checkups to closely and carefully monitor health and the status of your prostate cancer.

As long as the cancer is not growing or becoming more aggressive, you can avoid the immediate life-changing side effects of surgery, radiation therapy, or other treatments.

Half of men diagnosed with prostate cancer are low risk, meaning their cancer is unlikely to become life threatening. If you and your physician choose active surveillance, you will receive regular office visits, PSA tests, and digital rectal exams and may have a follow-up or repeat biopsy to see if your cancer is becoming more of a threat. If that happens, your doctor may advise you to begin a more aggressive treatment with surgery or radiation. To find out if your cancer may be low risk, take our eligibility quiz.

By choosing active surveillance, you are delaying or avoiding altogether the immediate and life-changing side effects of surgery, radiation therapy or other treatments. These side effects include urinary, bowel or sexual problems. However, you, as many men, may feel anxious or worried about not aggressively treating your cancer. Studies have shown that with close monitoring and careful patient selection, the risk of your prostate cancer progressing is extremely low. In fact, a recent publication showed that men who were followed under active surveillance had the same life expectancy with fewer side effects as those who had surgery.1   Both the American Cancer Society and the American Urological Association  endorse active surveillance as the treatment course for men with early, low risk prostate cancer. Remember that if you change your mind or have a change in your test results, you and your doctor can decide to start another treatment immediately.  

Although there is only a 3% chance that their disease will progress or become life-threatening, more than 100,000 U.S. men with low-risk prostate cancer undergo treatment with surgery or radiation each year.2  

Before choosing active surveillance, consider ...

Active surveillance is not right for every patient. You need to be willing and committed to attend regular follow-up doctor visits to check on your cancer, and you should be able to accept that the cancer will remain in your body. When considering this option, you and your doctor should carefully consider factors such as your PSA score, your tumor stage, your Gleason score, your age, your overall health and your concerns about the quality of your life going forward to give you more confidence in deciding if active surveillance is right for you.  Additionally,  you can have your tumor analyzed using the Oncotype DX prostate cancer test, which looks at 17 specific genes within your individual tumor to predict how aggressive your cancer is  – before you begin a treatment plan.    

Active Surveillance – Recommended Plan

  • PSA every 3 months, at least every 6 months
  • Biopsy within 18 months, then periodically as determined by your doctor.
  • Digital rectal exam (DRE) visits at 6 or 12 months  

NCCN Guidelines Version 1.2013 Prostate Cancer

1 Wilt, TJ, et al. Radical Prostatectomy versus Observation for Localized Prostate Cancer. NEJM.
2012;367(3):203-213.

2 Boorjian. 2008. J. Urol.