What is active surveillance?

Active surveillance is a way of monitoring prostate cancer that's contained inside the prostate (localised prostate cancer), rather than treating it straight away.

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

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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 do 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 do 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?


  • 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.


  • 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 while you are on active surveillance, 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 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 is growing, 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?


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