You’ll have regular tests to monitor your cancer. The tests aim to find any changes that suggest the cancer is growing. Depending on your hospital, you may have:
If your test results show that your cancer might be growing, you will be offered further tests to check on the cancer. If any changes are found, you can have treatment that aims to get rid of the cancer.
This is a blood test that measures the amount of prostate specific antigen in your blood. It's a useful test for monitoring prostate cancer. If your PSA level rises faster than expected, this could be a sign that your cancer is growing.
Your doctor may use your PSA level to work out the following:
- PSA velocity – how quickly your PSA level is rising. It is usually recorded as the change in your PSA level per year. For example, if your PSA level has increased from 3 to 4 over the last 12 months, your PSA velocity would be 1ng/ml/year.
- PSA doubling time – the time it takes for your PSA level to double. For example, if your PSA level has increased from 3 to 6 in one year, your PSA doubling time would be 1 year.
- PSA density – your PSA level in relation to the size of your prostate. For this you will have an ultrasound or an MRI scan to measure the size of your prostate. Your PSA density is then worked out by dividing your PSA level by the volume (size) of your prostate.
If your doctor is concerned by any of these test results, they might recommend an MRI scan or a prostate biopsy to check if the cancer is growing.
Read more about the PSA test.
Booking your PSA test
Depending on your hospital, you may have your PSA tests at your local hospital, or you may need to book these tests yourself at your GP surgery. Check with your doctor how often and where you should book your PSA tests. Give yourself plenty of time to book them, as hospitals and GP surgeries can be very busy and you may not be able to get an appointment straight away.
You should have an MRI scan when you first go on active surveillance to make sure your cancer hasn’t spread outside the prostate. You may then have regular MRI scans, although this will depend on your hospital. Your doctor may also suggest having an MRI scan if your PSA test or DRE results suggest your cancer might be growing. The scan can help your doctor decide if you need a biopsy. Read more about MRI scans.
Digital rectal examination (DRE)
This is where the doctor feels your prostate through the wall of the back passage (rectum). A normal prostate should feel soft and smooth. Your doctor will feel your prostate for any changes, such as hard or lumpy areas, that could suggest the cancer is growing. Read more about having a DRE.
Once you start active surveillance, you may only have another biopsy if other tests suggest your cancer is growing. Your PSA level might rise a little, even if your cancer isn’t growing. Your doctor will decide if it has risen enough for you to need a biopsy.
If you do have a biopsy that shows your cancer has grown, then your doctor may recommend you have treatment. This treatment will usually aim to get rid of the cancer. Read more about prostate biopsies.
How often will I have tests?
The tests you have, and how often you have them, will depend on your hospital. The following is an example, but your doctor will tell you how often you will have tests.
First year of active surveillance
- A PSA test every three to four months
- A DRE after 12 months
- An MRI scan after 12 to 18 months.
Second year onwards
- A PSA test every six months
- A DRE every 12 months.