Active surveillance

• Active surveillance means closely monitoring your prostate cancer with regular tests. These include PSA blood tests, digital rectal exams, MRI scans and repeat biopsies.
• Active surveillance is a way to avoid or delay unnecessary treatment and treatment side-effects. You may never need treatment for your prostate cancer, or you may avoid treatment for a number of years. 
• Slow-growing, low-risk prostate cancer may not grow or change for many years. You may never need treatment for your prostate cancer, or you may be able to hold off having treatment for several years.
• 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. If your cancer starts to change or grow, then you will be offered treatment.

If you have prostate cancer that is seen as low risk, you may be suitable for active surveillance. It may also be suitable for some intermediate-risk prostate cancers. It will also depend on your age, the amount of cancer in your biopsy and your general health. 

If you have high-risk cancer, you will not be suitable for active
surveillance, as your doctor will want to start active treatment to get the cancer under control.

Active surveillance involves regular tests to check (monitor) your cancer. If any changes are noticed, your doctor will talk to you about the need for treatment. The tests usually include:

• PSA blood tests done before each active surveillance appointment, usually every few months at the start, and then every 6 months after a couple of years. 
• Regular digital rectal exams – where the doctor examines your prostate gland through your rectum (back passage).
• Prostate biopsies (taking samples of prostate tissue). You may need one or more biopsies while on active surveillance.
• An MRI scan when you have started active surveillance. You may have several MRIs while you’re on active surveillance – often these happen every 2 years.

Your doctor will also ask if you have any new urinary or other symptoms.

Your doctor will talk to you about the need for more tests or treatment if:

• The PSA level rises.
• The MRI scan shows changes in size or location of your prostate cancer.
• Your doctor feels any changes during the rectal exam.
• There’s a change in the amount or the grade of cancer in the repeat biopsy sample.

Advantages of active surveillance

• No treatment-related side-effects, like urinary or sexual side-effects.
• Does not interfere with your everyday life.
• You can avoid unnecessary treatment – in many cases for years.
• You may never need treatment

Disadvantages of active surveillance

• You may feel anxious or worried about your cancer changing.
• Repeat tests and investigations are needed, which can be stressful.
• There is a chance that your cancer will grow while you are on active surveillance.  But low-risk prostate cancer often grows extremely slowly. The regular tests will help to pick up any changes at an early stage when you can still have successful treatment. 
• There is a small chance that your cancer will be more fast-growing than first thought. A more fast-growing prostate cancer benefits from earlier treatment.

• 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?  
• How often will I need repeat MRI scans?
• How often will I need repeat prostate biopsies? 
• How quickly would my PSA level have to rise for treatment to be considered necessary?
• What treatments could I have if my cancer grows?