Prostate Cancer Active Surveillance

Active surveillance, or watchful waiting, involves actively monitoring the course of the disease with the expectation to intervene if the cancer progresses. Patients under active surveillance must commit to a regular schedule of follow-up, which includes a prostate exam and prostate-specific antigen (PSA), and which may include repeat prostate needle biopsies, especially if you’re younger.

James Mohler, MD, NCCN Chair of the Prostate Cancer Treatment Panel and Chair of the RPCI Department of Urology

"One of the greatest challenges patients have is understanding that 40 to 50 percent of men diagnosed with prostate cancer can be safely monitored rather than undergoing immediate treatment. Nationally, the use of active surveillance is around 10 percent but it should be more like 40 or 50 percent." - James Mohler, MD, NCCN Chair of the Prostate Cancer Treatment Panel and Chair of the RPCI Department of Urology

Your doctor may offer this choice if:

  • You are older (less than a 20-year life expectancy) or have other health problems
  • You are diagnosed with early-stage prostate cancer that seems to be slow growing
  • Your Gleason score is 6 or less and your cancer is not detectable by rectal examination

The risks and potential side effects associated with treatment often outweigh the benefits in men with low and very low risk disease. The latest National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Oncology for Prostate Cancer recommend only active surveillance for those who meet the criteria for very low risk disease and have life expectancy less than 20 years.

Active surveillance avoids or delays the side effects of surgery and radiation, but this choice has risks. Rarely, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery and radiation therapy as you age. As with all treatment options, patients should discuss the pros and cons with their physicians.