Active surveillance of prostate cancer is an alternative to immediate treatment. It may be an option for those with low risk cancers.

Prostate cancer is a common cancer affecting individuals designated male at birth. It begins in the prostate gland, which produces seminal fluid.

Compared with other cancers, most prostate cancers grow slowly and are relatively low risk with limited aggressiveness. Due to this, many doctors now prefer the active surveillance approach to managing low risk cases of prostate cancer.

Active surveillance involves closely monitoring a person’s condition without an immediate active treatment, such as surgery or radiation. The objective is to avoid or delay the side effects of aggressive treatments while still maintaining the chance for a cure in the future if the cancer progresses.

This article looks at active surveillance for prostate cancer, when a doctor may recommend this option, and what to expect from this approach.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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People with low risk prostate cancer have four treatment options:

  • active surveillance
  • external radiotherapy
  • internal radiotherapy (brachytherapy)
  • surgery to remove the prostate

Doctors typically recommend active surveillance depending on a person’s life expectancy and for forms of prostate cancer that are low risk and slow-growing. This approach is often suitable under the following circumstances:

  • Unilateral involvement: The cancer affects only one side (lobe) of the prostate gland.
  • Limited involvement: The cancer affects less than half of the affected lobe.
  • Low aggressiveness: The cancer cells show minimal mutation and low aggression, indicating a slower disease progression. Typically, prostate-specific antigen (PSA) — a protein found in the prostate gland — levels are <10 nanograms per milliliter (ng/mL).
  • Absence of metastasis: The cancer has not spread to lymph nodes or formed tumors in distant areas.

When the risks of immediate treatment, such as surgery or radiation, outweigh the potential benefits, doctors consider active surveillance. This approach is suitable for people who can undergo regular monitoring and prefer to delay or avoid the side effects of more aggressive treatments that are unlikely to help them live longer.

Learn more about prostate cancer.

Active surveillance involves regular medical checkups. These checkups typically include the following components:

  • PSA blood tests: A doctor orders these PSA blood tests every 6 months. They are crucial in monitoring the levels of PSA in the blood, which can indicate prostate cancer activity.
  • Digital rectal exams (DRE): These annual tests involve a physician examining the prostate gland manually to detect abnormalities in size, shape, or texture.
  • Prostate biopsies: Doctors typically schedule prostate biopsies every 1–3 years. These procedures involve taking small tissue samples from the prostate to detect the presence of cancer cells and assess their aggressiveness.
  • Imaging tests: These may include transrectal ultrasounds or MRI scans. Doctors conduct them every 1–3 years to visually assess the prostate and detect any significant changes.

The exact schedule of these tests can vary based on factors such as:

  • a person’s age
  • their overall health
  • PSA levels
  • the results of previous biopsies

The goal of active surveillance is to monitor prostate cancer carefully and intervene with more aggressive treatment only if the cancer shows signs of progression.

The primary risk of active surveillance is the possibility of cancer progression during the monitoring period. However, low risk prostate cancer often grows extremely slowly or not at all, so many people do not require treatment.

There is also a risk of anxiety and stress associated with living with untreated cancer and undergoing regular tests.

Overall, the benefits of avoiding unnecessary treatment and its associated side effects often outweigh many of the risks of active surveillance.

Active surveillance and immediate treatment represent two distinct approaches to managing prostate cancer.

Doctors may choose active surveillance for low risk, slow-growing prostate cancer. The focus is on observing the cancer’s progression over time rather than trying to treat or cure it. The method avoids the immediate side effects of aggressive treatments, making it a preferred choice when the cancer is unlikely to spread or cause significant harm in the short term.

In contrast, doctors may recommend immediate treatment, such as surgery (radical prostatectomy) or radiation therapy for more aggressive or higher risk cancers. These treatments aim to remove or destroy cancer cells but come with significant side effects, including urinary incontinence, erectile dysfunction, and bowel issues.

The decision between active surveillance and treatment depends on various factors, including the following:

  • the stage and grade of the cancer
  • a person’s age
  • overall health status
  • personal preferences

Learn more about prostate cancer treatment.

The results of active surveillance vary depending on the individual case. Often, the cancer remains stable with minimal progression. If the cancer shows signs of becoming more aggressive or spreading, doctors adjust the treatment strategy.

Long-term outcomes from studies indicate that a large percentage of those under active surveillance do not require treatment for several years. For instance, research shows that the treatment-free probability after 5, 10, and 15 years of active surveillance can be as high as 76%, 64%, and 58% respectively. This means that a significant number of people with prostate cancer who opt for active surveillance may not need any treatment for up to 15 years.

Still, the likelihood of needing treatment increases gradually over time, but many can maintain a high quality of life without the side effects of more aggressive treatments.

Survival rates

Furthermore, in low risk prostate cancer cases, long-term metastasis-free and prostate cancer-specific survival rates are high. Around 99 out of 100 men will not die of prostate cancer in the first 10 years after receiving a diagnosis.

Active surveillance is a viable option for certain low risk prostate cancer cases. It focuses on monitoring over immediate treatment.

While active surveillance requires the inconvenience of regular medical checkups, it can prevent the side effects of more aggressive treatments. Individuals and doctors must work closely to monitor any changes that might require a shift in the management approach.