Understanding Active Surveillance as a Prostate Cancer Treatment Path
You may consider active surveillance if you are
diagnosed with early-stage, low-risk prostate cancer that grows slowly and is unlikely
to spread. Half of men diagnosed with prostate cancer are low risk, meaning their
cancer is unlikely to become life threatening. Active surveillance is a treatment
plan that closely and carefully monitors your health and the status of your prostate
cancer. 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.
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
Is active surveillance right for you?
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 certain genes within your individual
tumor to predict how aggressive your cancer is – before you begin a
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
2 Boorjian. 2008. J. Urol.