Most men who are diagnosed with prostate cancer have localized cancer, which means the cancer hasn't spread outside the prostate. Some men who have localized prostate cancer choose active surveillance, which allows them to avoid or delay having surgery or radiation. Active surveillance is an option for men with cancer that isn't likely to grow.
Tests will show if the cancer is likely to grow. With localized prostate cancer:
- Low-risk cancer isn't likely to grow right away. These men can choose active surveillance. This means their doctors will watch the cancer closely with regular checkups and tests to see if the cancer grows. This choice allows a man to delay having surgery or radiation, often for many years. If the cancer grows very slowly, treatment may never be needed.
- Medium-risk cancer is more likely to grow. Some men with this type of cancer may be able to choose active surveillance. Others may need to choose surgery or radiation.
- High-risk cancer is most likely to grow. Men with high-risk cancer will likely need to choose surgery or radiation.
Whether active surveillance is a good choice for you is something you will want to discuss with your doctor. Together you and your doctor will want to consider:
- Your life expectancy.
- The stage and Gleason score of your cancer.
- Your general health.
- The possible side effects you might have from other treatments.
Your personal preference needs to be part of this decision.
With active surveillance, you and your doctor will watch your cancer closely to see if it appears to be growing. During this time, you will have checkups and tests, such as PSA tests, digital rectal examinations, and prostate biopsies.
It may seem odd to have cancer and not have surgery to remove it or radiation therapy to kill the cancer. But unlike many other cancers, most prostate cancer grows very slowly. Slow-growing prostate cancer does not normally cause symptoms. So it is possible to have prostate cancer for years without ever knowing it.
Prostate cancer treatments like surgery and radiation have serious side effects. These side effects include bladder, bowel, and erection problems. With active surveillance, men can wait to start other treatment. Some men will never need more treatment. And others can delay having treatment until tests show their cancer is growing more quickly.
If you choose active surveillance, you are taking a chance that your cancer will grow. But regular checkups will show if this happens. And if it does happen your cancer still can be treated in the early stages, when treatments are more successful.
If active surveillance is not an option for you, your doctor probably will recommend other treatments. Each type of prostate cancer treatment has its pros and cons. And it is important that you and your doctor think about both when making your treatment decisions.
What To Expect After Treatment
Active surveillance sometimes continues for years. In other cases, tests eventually show that the cancer is growing and needs to be treated.
Why It Is Done
Prostate cancer is typically a slow-growing cancer. About 21,000 men are diagnosed with prostate cancer in Canada every year.footnote 2 In the United States, about 12 out of 100 men will get prostate cancer.footnote 1 But most men who are diagnosed with prostate cancer don't die from prostate cancer.
If your cancer is a low-risk cancer or a medium-risk cancer, active surveillance may be an option for you. With active surveillance, men can wait to start treatment. Some men will never need treatment. And others can delay treatment until tests show their cancer is growing more quickly.
How Well It Works
Men with localized prostate cancer who have a low chance that their cancer will spread can choose active surveillance. One study compared active monitoring (a watch-and-wait program like active surveillance), surgery, and radiation in men who had localized prostate cancer and found that the risk of dying was very low and about the same, no matter what option men chose.footnote 3
Another study looked at men with low-risk localized prostate cancer (and some men with intermediate-risk prostate cancer) and found that:footnote 4
- At 5 years, about 76 out of 100 men were untreated and still on active surveillance.
- At 10 years, about 64 out of 100 men were untreated and still on active surveillance.
- At 15 years, about 55 out of 100 men were untreated and still on active surveillance.
There is a chance that your prostate cancer will grow during active surveillance. If this happens, your doctor will recommend other treatment, such as surgery or radiation.
If you choose active surveillance, it's very important to follow your doctor's schedule of tests and examinations. Regular checkups will increase your chances of finding out right away if your prostate cancer grows. That way your cancer still can be treated in the early stages, when treatments are more successful.
What To Think About
If you choose active surveillance, you can change your mind at any time and have surgery or radiation, even if tests show that your prostate cancer hasn't changed.
Older men and men who have other serious medical conditions and aren't well enough to have surgery or radiation often choose watchful waiting. Watchful waiting means that you'll still be under the care of your doctor. But the goal of watchful waiting is to only treat symptoms that bother you. (For active surveillance, the goal is to cure the cancer if tests show that the cancer is growing.)
- National Cancer Institute (2017). SEER cancer stat facts: Prostate cancer. National Cancer Institute. www.seer.cancer.gov/statfacts/html/prost.html. Accessed July 10, 2017.
- Canadian Cancer Society's Advisory Committee on Cancer Statistics (2017). Canadian Cancer Statistics 2017. Toronto, ON: Canadian Cancer Society. Available online: http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2017-EN.pdf?la=en.
- Hamdy FC, et al. (2016). 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. New England Journal of Medicine , 375(15): 1415–1424. DOI: 10.1056/NEJMoa1606220. Accessed November 3, 2016.
- Klotz L, et al. (2015). Long-term follow up of a large active surveillance cohort of patients with prostate cancer. Journal of Clinical Oncology, 33(3): 272–277. DOI: 10.1200/JCO.2015.55.1192. Accessed August 14, 2015.
Current as of: April 29, 2020
Author: Healthwise Staff
E. Gregory Thompson MD - Internal Medicine
Brian D. O'Brien MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
Christopher G. Wood MD, FACS - Urology, Oncology
Richard M. Hoffman MD, MPH - Internal Medicine
Current as of: April 29, 2020