In men who have low grade and low volume prostate cancer (for instance in one side of the prostate and which is of a low grade e.g. Gleason 3+3) which is not detectable on examination (T1) and who have a low PSA which is below 10 it is unlikely that prostate cancer will progress rapidly. In fact several research studies have indicated that it may take some years for the cancer to become clinically significant or pose a threat to life expectancy. As treatment to cure prostate cancer will inevitably have side effects usually on potency and continence it can be beneficial for some men to adopt a policy of surveillance and have treatment to cure them if and when they need it, therefore avoiding any unnecessary and unwanted side effects for the immediate future.
Active surveillance involves a strict regime of PSA blood tests every 3-months and a DRE of the prostate every 6-months. A special type of MRI scan called a multiparametric MRI may be used to identify specific areas of cancer before a man starts active surveillance. A further scan may then be performed at a later stage. Further biopsies of the prostate are usually recommended after 12-18 months to see if there is any evidence the cancer has progressed. If during this surveillance period the PSA level increases significantly (for instance by a value of 2), or a man decides that he wants to have treatment for his cancer then potentially curative treatment will be initiated. It is likely that if progression does occur there should be no difference in the chance of cure rate at this stage then there was when a man was diagnosed.
Active surveillance has become more popular and more widely used in recent years and can also be suitable for some older men with slightly more significant prostate cancer. The advantages are that side effects of treatment can be avoided possibly for some years without lessening the effectiveness of a cure for the prostate cancer if and when disease progression occurs.
However some men do not wish to live with the uncertainty that they have prostate cancer which is not being treated and which may in time may progress. They may therefore wish to have treatment at an early stage.
Active surveillance is an individual choice and there is no right or wrong decision. If active surveillance has been recommended it will have been a decision made by a group of specialists at an Multi Disciplinary Team meeting (MDT) and will have been deemed suitable for a man’s particular circumstance.
Active surveillance is not the same as watchful waiting.
Last reviewed April 2021. Next review 2022.
References available on request.