Frequently Asked Questions About Active Surveillance

What Is Active Surveillance?

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 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.

What Does Active Surveillance Involve?

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:

  • PSA tests
  • digital rectal exams (DRE)
  • MRI scans
  • prostate biopsies

These tests are used to find any changes that suggest the cancer is growing. If any changes are found, then your doctor will recommend treatment to get rid of the cancer.

Are There Any Side-Effects?

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.

Who Is Eligible For Active Surveillance?

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:

  • PSA density (blood PSA level ÷ by prostate volume) of less than 0.15
  • Low volume of localized cancer
  • Biopsy Gleason score of 3+3=6 (Grade Group 1)

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.

What Are The Advantages And Disadvantages Of Active Surveillance?

Advantages of Active Surveillance

  • As you won’t be undergoing treatment while you’re on active surveillance, you’ll avoid the side effects associated with treatment.
  • Active surveillance won’t affect your everyday life as much as having treatment would.
  • If test results do show that your cancer is growing, there are treatments available that can still cure it

Disadvantages of Active Surveillance

  • You may need to have more prostate biopsies performed which can cause side-effects, as well as being uncomfortable or painful
  • Your cancer might grow more quickly than expected and become harder to treat – however this is very uncommon
  • Your general health could potentially change and this change could make some treatments unsuitable
  • Not having treatment can cause high levels of anxiety, in some men, about the possibility of their cancer growing

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.

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