Active surveillance is a way of monitoring slow-growing prostate cancer, rather than treating it straight away. The aim is to avoid unnecessary treatment, or delay treatment and the possible side effects.

Active surveillance is a way of monitoring prostate cancer that's contained inside the prostate (localised prostate cancer), rather than treating it straight away. The aim is to avoid treatment unless there are signs your cancer may be growing.

It might seem strange not to have treatment, but prostate cancer is often slow-growing and may not cause any problems in your lifetime. In other words, you might never need any treatment.

Many treatments for prostate cancer can cause side effects, such as leaking urine, difficulty getting and keeping an erection, and bowel problems.  For some men these side effects may be long term and have a big impact on their daily lives.

If you decide to go on active surveillance, you won’t have any treatment unless your tests show that your cancer may be growing – so you’ll avoid or delay these side effects.

If there are signs your cancer may be growing, you will be offered treatment which aims to cure it.

See all treatment choices

Watch Robin's story for one man's experience of being on active surveillance:

Listen to a summary of this page

What's the difference between active surveillance and watchful waiting?

Active surveillance is often confused with watchful waiting – this is another way of monitoring prostate cancer. The aim of both is to avoid having unnecessary treatment. But there are key differences between them.

Active surveillance

  • If you need treatment, it will aim to cure the cancer.
  • It is suitable for some men with cancer that is contained in the prostate (localised cancer).
  • It usually involves more regular hospital tests, such as prostate biopsies and MRI scans.

Watchful waiting

  • If you need treatment, it will aim to control the cancer rather than cure it.
  • It’s generally suitable for men with other health problems who may be less able to cope with treatments such as surgery or radiotherapy, or whose cancer may never cause problems during their lifetime.
  • It usually involves fewer tests, and these usually take place at the GP surgery rather than at the hospital.

Who can go on active surveillance?

Active surveillance is suitable for men with localised prostate cancer that is less likely to spread (low risk).

It may also be suitable for some men with cancer that may be more likely to spread (medium risk), who want to avoid or delay treatment. Your doctor or nurse will discuss whether it is an option for you.

What are the advantages and disadvantages?

Advantages

  • As you won’t have treatment while you’re on active surveillance, you’ll avoid the side effects of treatment.
  • Active surveillance doesn’t interfere with your everyday life as much as treatment might do.
  • If tests show that your cancer might be growing, there are treatments available that aim to cure it.

Disadvantages

  • You might need to have more prostate biopsies which can cause side effects, and which some men find uncomfortable or painful.
  • There is a chance that your cancer might grow more quickly than expected and become harder to treat.
  • Your general health could change, which might make some treatments unsuitable for you if you did need them.
  • Some men may worry about not having treatment, and about their cancer growing.

What may be an advantage for one person might not be for someone else. If you’re offered active surveillance, speak to your doctor or nurse before deciding whether to go on it – they’ll be able to help you decide whether it’s the right option for you.

What does active surveillance involve?

If you're on active surveillance you will have regular tests to monitor your cancer.

The tests used vary from hospital to hospital, but you may have:

  • a PSA test every three months to six months
  • a digital rectal examination (DRE) every six to 12 months
  • a prostate biopsy about a year after you were diagnosed, and then every few years, depending on your treatment centre
  • an MRI scan if your PSA test or DRE results suggest the cancer is growing.

If the results of the tests show your cancer has grown, you’ll be offered treatment which aims to cure the cancer – for example, surgery or radiotherapy.

Will I need treatment?

If the results of the tests show your cancer has grown, you’ll be offered treatment which aims to cure the cancer – for example, surgery or radiotherapy.

Most men on active surveillance have treatment because their tests show their cancer has changed. But some men decide they want to have treatment even though there are no signs of any changes. This is often because they’re worried their cancer will spread. If you decide you do want treatment, speak to your doctor or nurse about your options.

Are there any risks with active surveillance?

Changes to your cancer

There’s a chance that your cancer could grow. But the tests used to monitor your cancer aim to find any changes early enough to treat it.

There’s always a small chance that changes might be missed. This means there’s a small chance that the cancer will spread outside your prostate before being picked up, and treatment might not be able to get rid of it.

Research shows active surveillance is a safe way of avoiding unnecessary treatment for men with low risk prostate cancer.

Talk to your doctor or nurse about the risk of your cancer growing.

Changes to your health

There’s a chance that your general health could change, which would make some treatments unsuitable for you if the cancer did grow. For example, if you were to get heart problems, you might not be able to have surgery to remove the prostate, as an operation might not be safe for you.

Concerns about active surveillance

Active surveillance isn’t for everyone. You might find it difficult not having treatment for prostate cancer, and worry that it will change or spread. Some men on active surveillance decide to have treatment even though there are no signs of any changes in their cancer – because they’re worried about it growing.

If at any time you decide that you want treatment, talk to your doctor or nurse about your treatment options. You don’t have to stay on active surveillance if you don’t want to.

Are there any side effects?

As active surveillance involves no treatment there are no physical side effects. But you might need to have prostate biopsies every few years.

Having a biopsy may cause some short term side effects such as infection, and blood in the urine, or semen or bowel movements. About 3 in 50 men (six per cent) may get a serious infection after a trans-rectal ultrasound (TRUS) guided prostate biopsy. You will have antibiotics before your biopsy to help prevent infection.

Questions to ask your doctor or nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • How often will I have my PSA level checked?
  • Who will check my PSA level and give me the results?
  • How often will I see my doctor or nurse?
  • How often will I have a digital rectal examination (DRE)?
  • Will I need more prostate biopsies and how often?
  • Will I need to have any scans?
  • How quickly would my PSA level have to rise for you to recommend treatment?
  • What are the advantages and disadvantages of active surveillance?
  • What treatments could I have if my cancer grows?
  • What can I do to improve my overall health?

References

  • Full list of references used to produce this page  

    1. Heidenreich A, Bastian PJ, Bellmunt J, et al. Guidelines on prostate cancer. European Association of Urology, March 2013
    2. Prostate cancer: diagnosis and treatment. National Institute for Health and Clinical Excellence (NICE). January 2014. Clinical guideline 175
    3. Selvadurai ED, Singhera M, Thomas K, et al. Medium-term outcomes of active surveillance for localised prostate cancer. Eur Urol 2013;64(6):981–87  
    4. Albertson PC. When is active surveillance the appropriate treatment for prostate cancer? Acta Oncologica 2011;50(1):120–26
    5. Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012;367:203–13
    6. Bul M, Zhu X, Valdagni R, et al. Active surveillance for low-risk prostate cancer worldwide: The PRIAS Study. Eur Urol 2013;63(4):597–603
    7. Klotz L. Active Surveillance: The Canadian Experience with an “Inclusive Approach”. J Natl Cancer Inst Monogr 2012;45:234–41
    8. Klotz L. Active surveillance for favorable-risk prostate cancer: who, how and why? Nat Clin Pract Oncol 2007;4(12):692–8
    9. McVey GP, McPhail S, Fowler S, et al. Initial management of low-risk localized prostate cancer in the UK: analysis of the British Association of Urological Surgeons Cancer Registry. BJU Int 2010;106:1161–64
    10. Yacoub JH, Verma S, Moulton JS, et al. Imaging-guided prostate biopsy: conventional and emerging techniques. Radiographics 2012;32(3):819–37
    11. Sfoungaristos S, Perimenis P. PSA density is superior than PSA and Gleason score for adverse pathologic features prediction in patients with clinically localized prostate cancer. Can Urol Assoc J 2012;6(1):46–50
    12. Raaijmakers R, de Vries SH, Blijenberg BG, et al. hK2 and free PSA, A prognostic combination in predicting minimal prostate cancer in screen-detected men within the PSA range 4–10 ng/ml. Eur Urol 2007;52:1358–64
    13. Van As N, Norman A, Woode-Ammissah R, et al. Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance.  Eur Urol  2008;54(6):1297–305
    14. Kazer MW, Psutka SP, Latini DM, Bailey Jr DE. Psychosocial aspects of active surveillance. Curr Opin Urol 2013;23(3):273–77
    15. Keyes M, Crook J, Morton G, et al. Treatment options for localized prostate cancer. Canadian Family Physician 2013;59:1269–74
    16. Palermo G, Pinto F, Totaro A, et al. High-intensity focused ultrasound in prostate cancer: Today's outcomes and tomorrow's perspectives. Scandinavian J Urol  2013;47(3):179–87
    17. Glass AS, Cooperberg MR, Meng MV, Carroll PR. Role of active surveillance in the management of localized prostate cancer. J Natl Cancer Inst Monogr 2012;45:202–6
    18. Loeb S, Vellekoop A, Ahmed HU, et al. Systematic review of complications of prostate biopsy. Eur Urol 2013;64:876–92
    19. Prostate cancer. Follow-up and monitoring. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2011
    20. Thompson J, LawrentschukN, FrydenbergM, et al. The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Intl 2013;112:6–20
    21. Morgan VA, Riches SF, Thomas K, et al. Diffusion-weighted magnetic resonance imaging for monitoring prostate cancer progression in patients managed by active surveillance.Br J Radiol 2011;84:31–37
    22. Dall’Era MA, Cowan JE, Simko J, et al. Surgical management after active surveillance for low-risk prostate cancer: pathological outcomes compared with men undergoing immediate treatment. BJU Intl 2011;107:1232–37
    23. Klotz L. Prostate cancer overdiagnosis and overtreatment. Curr Opin Endocrinol Diabetes Obes 2013;20(3):204–9
    24. Klotz L. Zhang L, Lam A, et al. Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort With Localized Prostate Cancer. J Clin Oncol 2010;28(1):126–31
    25. Van Patten CL, de Boer JG, Tomlinson Guns ES. Diet and dietary supplement intervention trials for the prevention of prostate cancer recurrence: A review of the randomized controlled trial evidence. J Urol 2008;180:2314–22
    26. Chan JM, Holick CN, Leitzmann MF, et al. Diet after diagnosis and the risk of prostate cancer progression, recurrence, and death (United States). Cancer Causes Control 2006;17(2):199–208
    27. Mishra SI, Scherer RW, Snyder C, et al. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 2012
    28. Davies NJ, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal and prostate cancer survivorship: a review of the literature. Br J Cancer 2011;105(1):S52–73
    29. Richman EL, Kenfield SA, Stampfer MJ, et al. Physical activity after diagnosis and risk of prostate cancer progression: Data from the cancer of the prostate strategic urologic research endeavor. Cancer Res 2011
    30. Thorsen L, Courneya KS, Stevinson C, Fossa SD. A systematic review of physical activity in prostate cancer survivors: outcomes, prevalence, and determinants. Support Care Cancer 2008;16:987–97