Active surveillance

Active surveillance is a way to avoid or delay unnecessary treatment if your cancer is slow growing. Prostate cancer may not grow or change for many years. It may not cause any symptoms or threaten you in any way. In other words, you may not need treatment for your prostate cancer ever, or you may be able to defer your treatment for a number of years.

For prostate cancer found at an early stage, which is of low risk, active surveillance may avoid or delay treatment without risk to your health. Treatments for prostate cancer often cause side-effects that can affect your quality of life, so you could choose to have active surveillance rather than treatment.


Who can have active surveillance?

If you have prostate cancer that is seen as low risk, you may be suitable for active surveillance. If you have a medium-risk prostate cancer, you may be suitable too. See the Gleason score risk table for more information. Your suitability for active surveillance will also depend on your age and your general health and the details of the prostate biopsy result. If you have high-risk cancer, in general you will not be suitable for active surveillance. Your doctor will discuss this with you in more detail.

What does active surveillance involve?

Active surveillance involves regular tests to check (monitor) your cancer. These tests aim to find any changes in the cancer. If any changes are noticed, your doctor will talk to you about the need for treatment. The tests usually include:
PSA blood tests every few months at the start, and then every 6 months after a  couple of years.
Digital rectal exams repeated every 3 to 6 months at the start and then perhaps less often after the first 2 years.
Prostate biopsies,usually repeated after 1 year and then every couple of years. 
Because no physical treatment is involved, there are no physical side-effects. This means active surveillance does not interfere with your everyday activities.
During the surveillance, you may become anxious or worry about your cancer changing. If this is how you feel, then active surveillance may not be the best choice for you. Remember that if you change your mind after starting active surveillance you can tell your doctor at any stage that you would like to have treatment.

What happens if the results of my tests change?

  • PSA: A rise in your PSA level may be a sign that your cancer has started to grow. If this happens, your doctor will look at how quickly your PSA is changing. If your PSA level is rising, your doctor will discuss if you need to have treatment or not.
  • Biopsy results: You may be offered treatment if your repeat biopsy shows a change in the amount or the grade of cancer; for example, if the biopsy detects some cancer with a higher Gleason score.
  • Digital rectal exam: If your doctor feels any changes during a physical exam, he or she will discuss with you if you need treatment or more tests.

Is active surveillance risky?

There is a chance that your cancer will grow while you are on surveillance. But your tests aim to pick up any changes at an early stage when you can still have successful treatment.

Even though the tests can pick up changes, there is also a chance that changes in your cancer may not be picked up. There is also a small chance that your cancer will be faster growing than first thought. This is why the biopsy is repeated.

A more fast-growing prostate cancer benefits from earlier treatment.  You can discuss all the advantages and disadvantages of active surveillance before you decide on this option. 

Advantages of active surveilance

  • No physical side-effects
  • Does  not interfere with everyday life
  • You may never require the treatment of the prostate cancer


Disadvantages of active surveillance

  • You may become anxious or worried about your cancer changing
  • Repeat biopsies are needed
  • The cancer may grow more quickly than expected

If you are considering active surveillance as an option it may be helpful to ask some of the following questions so that you know what to expect in the future as well as understand how your follow-up will be managed, and by whom:

  • How often will I need to have my PSA level checked? 
  • Who will check my PSA level and give me the results? 
  • How often will I have to go back for check-ups? 
  • How often will I have a digital rectal examination? 
  • When will I need repeat prostate biopsies and how often? 
  • How quickly would my PSA level have to rise for treatment to be considered necessary?
  • What treatments could I have if my cancer grows

Remember your active surveillance appointments

  • It is very important to keep any future appointments that are arranged for you as part of your active surveillance programme.
  • Write the date and time down on a calendar to remind yourself closer to the time.
  • If you cannot make the arranged appointment then make one for another day by contacting the urology clinic in the hospital and speak with your prostate cancer nurse specialist. 
Call the National Cancer Helpline on Freephone 1800 200 700 if you would like to request a print copy of the Prostate Passport, a small booklet where you can keep a record of you PSA blood results and your clinic appointment dates. You can view the Prostate Passport here.
If you prefer, you can also visit a Daffodil Centre. Find your nearest Daffodil Centre here.
Date Last Reviewed: 
Wednesday, July 9, 2014
Date Last Revised: 
Wednesday, April 15, 2015