Active surveillance is a proactive management strategy for men with low-risk or very-low-risk prostate cancer. Instead of initiating immediate treatment, patients are closely monitored over time with routine testing. The goal is to avoid or delay treatment-related side effects such as urinary incontinence or erectile dysfunction, without compromising long-term outcomes.
Who Is a Candidate?
Active surveillance is typically recommended for patients with:
- Low-risk prostate cancer (Gleason score ≤ 6)
- Low PSA levels (usually <10 ng/mL)
- Cancer confined to the prostate (clinical stage T1-T2a)
- Minimal cancer involvement on biopsy (small volume disease)
It may also be considered for select men with favorable intermediate-risk disease based on shared decision-making.
How Monitoring Works
Patients on active surveillance undergo regular evaluations to assess whether the cancer remains stable or shows signs of progression. These evaluations usually include:
- PSA blood tests every 3–6 months
- Digital rectal exams (DRE) at regular intervals
- Prostate biopsies every 1–3 years (or as indicated)
- Prostate MRI to help assess tumor size and location
If these tests show the cancer is growing or becoming more aggressive, curative treatment (such as surgery or radiation) can be initiated at that time.
Benefits of Active Surveillance
- Avoids overtreatment: Many prostate cancers grow very slowly and may never cause symptoms or harm during a patient’s lifetime.
- Preserves quality of life: Defers the side effects of treatment until (or unless) they are necessary.
- Provides time for decision-making: Patients retain the option to pursue treatment if cancer progresses.
Potential Drawbacks
- Regular testing: Requires commitment to ongoing appointments and biopsies.
- Anxiety: Some men may feel anxious living with an untreated cancer, even if the risk is low.
- Risk of progression: Although closely monitored, there’s a small chance the cancer could progress between testing intervals.
Is It Safe?
Yes, for appropriately selected patients. Studies have shown that active surveillance offers excellent long-term outcomes for low-risk prostate cancer, with cancer-specific survival rates exceeding 99% at 10 years. It’s a widely accepted approach endorsed by major urologic and cancer organizations.
Active surveillance is not the same as doing nothing—it is an evidence-based strategy that emphasizes safety, quality of life, and timely intervention when needed.