Treatment

Active surveillance

Active surveillance is a way of monitoring prostate cancer which aims to avoid or delay unnecessary treatment in men with less aggressive cancer.

Prostate cancer can be slow growing and, for many men, the disease may never progress or cause any symptoms. In other words, many men with prostate cancer will never need any treatment.

Treatments for prostate cancer may cause side effects which can affect your quality of life. By monitoring the cancer with regular tests, you can avoid or delay these side effects.

Active surveillance is suitable for men with low risk early stage prostate cancer that is contained within the prostate gland (localised prostate cancer). It may also be suitable for some men with intermediate risk cancer. Your doctor or nurse will discuss whether it is an option for you.

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Contents

Watch Robin's story for one man's experience of being on active surveillance:

What is the difference between active surveillance and watchful waiting?

Watchful waiting and active surveillance are both ways of monitoring prostate cancer and avoiding immediate treatment. However, there are some differences, including:

  • who may be suitable for each approach
  • what kind of tests you will have and how often you will have them.

Active surveillance usually involves more regular hospital tests, including prostate biopsies. The aim is to treat the cancer promptly if it shows signs of changing and to try to get rid of it completely.

Watchful waiting usually involves check-ups at the GP surgery rather than at the hospital. Check-ups usually happen less often than with active surveillance. The aim is to treat the cancer if it starts causing problems or symptoms.

Read our online fact sheet for more information.

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What are the advantages and disadvantages?

Advantages

  • As there is no treatment involved, there are none of the physical side effects.
  • It does not interfere with your everyday life as much as treatment.

Disadvantages

  • You may need to have more prostate biopsies which can cause short term side effects, and which some men find uncomfortable.
  • There is a small chance that the cancer may grow more quickly than expected and become more difficult to treat.
  • Some men may become anxious or worry about their cancer changing.

What might be an advantage for one person may not be for someone else. Talk to your doctor or nurse about your own situation.

You can read our online fact sheet for more information about the advantages and disadvantages of active surveillance.

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What does active surveillance involve?

If you have active surveillance, your prostate cancer will be monitored with regular tests.

Monitoring will usually involve:

The tests aim to find any changes that suggest that the cancer is growing. Treatment can then be offered at an early stage, with the aim of getting rid of the cancer completely.

For more information on what active surveillance involves read our online fact sheet.

You can read more about the treatments for prostate cancer on our treatment choices pages.

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Are there any side effects?

As active surveillance involves no treatment there are no physical side effects. But you may need to have prostate biopsies every few years.

Having a biopsy may cause some short term side effects such as blood in your urine, faeces or semen. About 1 in 50 men (two per cent) are at risk of developing a serious infection after biopsy. You will have antibiotics before your biopsy to help prevent infection.

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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?
  • Will I need repeat prostate biopsies and how often?
  • How quickly would my PSA level have to rise for you to recommend treatment?
  • What are the risks and benefits of active surveillance for me?
  • What treatments could I have if my cancer grows?

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References

You can find a full list of references used to produce this page in our online fact sheet.

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