Active surveillance is a treatment plan that involves closely monitoring a patient’s condition, but not providing any treatment unless there are changes in test results that show the condition is getting worse. It is also called active monitoring. It is the preferred option for the initial management of men with localized low-risk prostate cancer. Active surveillance is also used to avoid or delay the need for treatments which can cause side effects or other health-related problems. If there are signs that the cancer may be growing, the patient will be offered a treatment.
This approach may be suitable for early prostate cancer due to the fact this disease often grows slowly and may never cause life-threatening effects. Some prostate cancer patients may never need treatment.
During active surveillance, certain exams and tests are done on a regular schedule. The tests you have, and how often you have them, will depend on your doctor. These include:
Also, the doctor will take into account the time needed for the PSA level to double (eg: from 3 to 6). This is the PSA doubling time.
The PSA density is also an important factor to be taken into account. First of all, the doctor will measure the size of your prostate, probably through an MRI scan. After that, he will divide the PSA level to the volume of your prostate.
If there is a factor that may concern the doctor, he will probably recommend a biopsy to test whether the cancer is growing.
These tests are used to find any changes that suggest the cancer may be growing. You may have a PSA test every 3-4 months, a DRE exam after 12 months of monitoring and an MRI scan even more rarely. Starting with the second year of active monitoring, a PSA test, for example, can be done each 6 months. If any changes are found, then your doctor will recommend treatment to get rid of cancer.
There are men who decide upon treatment even though there are no changes that may suggest that the cancer is growing. Talk to your doctor about your concerns.
Since you won’t be undergoing any specific treatment while you’re on active surveillance, there are no physical side effects. However, you may need to have prostate biopsies performed while on active surveillance, which itself can cause some short-term side effects. Now, many hospitals do MRI scans, which are not invasive, instead of prostate biopsies and avoid many side-effects caused by regular biopsies.
Active surveillance is suitable for men with localized prostate cancer that has a low risk of spreading (metastasizing). It’s also sometimes suitable for men with intermediate (medium) risk prostate cancer who want to avoid or delay treatment. Criteria for eligibility include:
Your doctor will also take other factors into account, including the cancer’s stage, the patient’s age, health, family history, and personal preference. A patient’s race and ethnicity are also important factors.
As helpful as active surveillance can be for those with low-risk prostate cancer, it isn’t right for everyone. You need to be both willing and committed to attend regular follow-up doctor visits to check on your cancer. When considering this option, you and your doctor should carefully consider factors such as your PSA score, tumor stage, Gleason score, your age, your overall health and any concerns you may have about the quality of your life going forward.
Watchful waiting is another way of monitoring prostate cancer, even though it is often confused with active surveillance.
Active surveillance is suitable for men who can still benefit from prostate cancer treatment while watchful waiting is for men who suffer from other diseases or are too old to undergo a prostate cancer treatment.
Men who are on active surveillance can have their cancer cured, while men who are on watchful waiting can only have treatment to keep cancer under control and manage symptoms.
Active surveillance involves many prostate tests, such as regular PSA tests and DRE exams/ MRI scans or biopsies. Watchful waiting is a much more passive approach, involving fewer tests. Follow-ups are usually determined by changes in the symptoms.
Talk to your doctor about whether one of these two approaches would be suitable for you and ask him/her to explain what each approach would involve.
Make sure to read about the other prostate cancer treatment options: