Active surveillance for prostate cancer

September, 25th, 2024

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During active surveillance for prostate cancer, your prostate cancer is closely monitored for any changes. Active surveillance for prostate cancer is sometimes called expectant management.

No cancer treatment is provided during active surveillance for prostate cancer. This means medications, radiation and surgery aren’t used. Periodic tests are done to check for signs the cancer is growing.

You might consider active surveillance for prostate cancer if your cancer is small, expected to grow very slowly, confined to one area of your prostate, and isn’t causing signs or symptoms.

If you have other health problems that limit your life expectancy, active surveillance for prostate cancer may also be a reasonable approach.

Why it’s done

Active surveillance for prostate cancer is used to avoid treatment side effects when the risk of the prostate cancer progressing is very low.

Because prostate cancer grows very slowly, some very small cancers may never cause signs and symptoms. Many who choose active surveillance live out their normal life spans before the cancer ever grows large enough to require treatment.

Active surveillance for prostate cancer may be appropriate for you if:

• Your cancer is small. If your cancer is found early, while it’s still small and limited to one area of your prostate, active surveillance may be a reasonable choice.
• Your Gleason score is low. Active surveillance may be best suited if you have a low Gleason score (usually 6 or lower), which indicates a less aggressive, slower growing form of cancer.
• You have other serious health problems. If you have other advanced health problems — such as severe heart disease — that limit your life expectancy and that could potentially be made worse by treatment of prostate cancer, you may opt for active surveillance.

Risks

Risks of active surveillance for prostate cancer include:

• Anxiety. You may be anxious and have a sense of uncertainty about the status of your cancer.
• Frequent medical appointments. If you choose active surveillance, you must be willing to meet with your health care provider every few months.
• Cancer growth. The cancer can grow and spread while you wait. If cancer spreads, you may miss the window of opportunity for effective treatment.
• Fewer treatment options. If your cancer spreads, you may have fewer options for treatment. Your treatment options may be more drastic than treatments used for very small cancers.

What you can expect

During active surveillance, you’ll have regular visits with your health care team to monitor the cancer, usually every few months.

At these visits, tests and procedures might include:

• Digital rectal exam. During a digital rectal exam, your health care provider examines your prostate gland by gently inserting a lubricated, gloved finger into your rectum. Your provider can feel the surface of the prostate and assess whether the cancer has grown.
• PSA blood test. A PSA test measures the amount of prostate-specific antigen (PSA) in your blood. If your PSA rises, it may indicate cancer growth.

• Ultrasound or magnetic resonance imaging (MRI). If other tests raise concerns, your may need a transrectal ultrasound or MRI to further evaluate your prostate.

  During an ultrasound, a small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create an image of your prostate gland. During an MRI, you lie inside a machine that uses radio waves to create cross-sectional images of your prostate.

• Collection of prostate cells (prostate biopsy). Collecting samples of cells from within your prostate is usually recommended one year after active surveillance begins. Biopsy may be repeated occasionally to determine how much the cancer has grown and to reevaluate your Gleason score to see if the cancer remains slow growing.

Results

Many who choose active surveillance for prostate cancer never undergo prostate cancer treatment. The cancer may never grow and may never cause signs and symptoms.

But prostate cancer treatment might be considered if:

• The cancer begins growing faster than expected
• The cancer spreads outside a confined area within the prostate
• The cancer causes signs and symptoms

Treatment options for prostate cancer depend on your particular situation, but may include surgery, medications and radiation.