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What to Know About Active Surveillance for Prostate Cancer

If you’re diagnosed with prostate cancer, you may worry about the side effects you might face from treatment. You’ve probably heard that, because of the location of the prostate, treatment could cause short-term or long-lasting issues with your bladder, bowel or sexual functioning. 

For some men who don’t have advanced prostate cancer, active surveillance might be a good treatment option. Active surveillance is a plan of watchful waiting where your health care team carefully watches for changes in your prostate cancer. If your cancer is slow growing and isn’t progressing, you continue to monitor it. As long as nothing changes, you can postpone other types of treatment.

Joseph Mashni, MD, a surgical oncologist and urologist at Banner MD Anderson Cancer Center at Banner Gateway Medical Center, answered some questions about active surveillance. He explained that it involves: 

  • Routine doctor’s appointments for screening
  • Lab tests to check your prostate-specific antigen (PSA blood test) 
  • Physical examinations such as a digital rectal exam (DRE)
  • Advanced imaging such as a multiparametric MRI, which gives a more detailed look at your prostate
  • Prostate biopsies to confirm findings
  • In some cases, testing of your genes or the genes in the tumor 

Who could qualify for active surveillance?

For men with low-risk prostate cancer, active surveillance is probably an option. Low-risk prostate cancer means the cancer is only found in the prostate and is expected to grow very slowly.

You may also choose active surveillance if you have another serious health condition, like severe heart disease, that may limit your life expectancy. In that case, the other health conditions are of more concern and potentially more life-threatening than the prostate cancer. Other treatment options could also make those conditions worse.

What are the benefits of active surveillance?

With active surveillance, you can minimize the side effects of prostate cancer treatment without jeopardizing your life or your health. Other treatments for prostate cancer can include surgery, radiation, hormone treatments, chemotherapy, immunotherapy, or techniques that use cryotherapy (freezing) or HIFU (heat). These treatments may change how you urinate, have bowel movements or perform sexually. “Active surveillance is a way of safely postponing these more invasive treatments,” Dr. Mashni said. 

How can you determine if active surveillance is right for you?
You’ll want to talk through the pros and cons with your health care team. Your age and other health issues are crucial points to consider when deciding whether you want to move forward with active surveillance. 

It’s also important to remember that “active” is an essential part of active surveillance. You need to have your PSA scores tested every six months and have a follow-up biopsy within 12 to 18 months. If you don’t feel you can commit to the necessary follow-up testing, active surveillance might not be the best choice for you.

You also have to be comfortable with the idea that you’re living with cancer. If knowing there’s cancer in your prostate makes you anxious, treating your cancer another way might be a better choice. 

What are outcomes typically like for active surveillance?

Research has found that, in about half of cases, active surveillance is all that’s necessary. In the other half of cases, the surveillance finds that cancer has progressed to the point where another type of treatment is needed. But that doesn’t mean active surveillance didn’t work. 

“Delaying treatment can mean delaying side effects for many years. And, in that time, technology can advance, and new treatment options could become available,” Dr. Mashni said. 

Studies have also found that the risk of dying from prostate cancer after active surveillance is very low. 

The bottom line

If you’re diagnosed with prostate cancer, active surveillance, or carefully monitoring to see if that cancer has advanced, might be a treatment option for you. Active surveillance can prevent or delay the side effects of other types of treatment that can lead to trouble with urination, bowel function and sexual activity. To learn more about treatment options for prostate cancer, talk with your health care provider or find one near you at

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