Active surveillance is a way of closely monitoring some localised prostate cancers instead of starting treatment straight away. It is intended for cancers that are thought to have a lower risk of causing harm in the near future.
The aim is to avoid or delay the side effects of treatment while still keeping the option of treatment intended to cure the cancer if there are signs that it is progressing.
Read NHS information about prostate cancer treatment.
Who may be offered active surveillance?
Active surveillance is most commonly considered for people with localised prostate cancer that is at lower risk of growing or spreading. NICE recommends active surveillance for CPG 1 prostate cancer and recommends discussing it as an option for some people with CPG 2 disease. It may also be considered in selected cases of CPG 3 disease when treatment options are being discussed.
Your specialist team will take into account your PSA level, MRI findings and biopsy results, cancer grade and stage, general health and personal preferences when deciding whether active surveillance is suitable for you.
Read NICE recommendations on active surveillance.
What does active surveillance involve?
Active surveillance involves regular follow-up rather than simply waiting for symptoms. The exact schedule varies according to your individual risk and local protocol, but may include:
- regular PSA blood tests
- appointments with your specialist team
- repeat MRI scans
- repeat prostate biopsy in some circumstances
The purpose of these checks is to look for signs that the cancer is changing or becoming more likely to cause harm.
When might treatment be recommended?
If follow-up tests suggest that the cancer is progressing, your specialist team may recommend moving from active surveillance to treatment intended to cure or control the cancer, such as surgery or radiotherapy.
Treatment may also be considered if your own preferences change and you no longer feel comfortable remaining on active surveillance.
Active surveillance is not the same as watchful waiting
Active surveillance and watchful waiting are different approaches.
Active surveillance is a structured monitoring programme used when treatment intended to cure the cancer may still be appropriate if the cancer changes.
Watchful waiting usually involves less intensive monitoring and is generally used when avoiding the burden of treatment is more important than trying to cure the cancer. Treatment is then introduced mainly to control symptoms if needed.
See our Watchful Waiting page for more information.
Benefits and possible disadvantages
Possible benefits include avoiding or delaying treatment side effects such as urinary problems, erectile dysfunction and bowel problems.
Possible disadvantages include anxiety about living with untreated cancer, repeated tests and the small risk that the cancer could progress between follow-up appointments.
Your specialist team can help you weigh these benefits and disadvantages in the context of your own cancer.
Lifestyle and active surveillance
A healthy lifestyle can support your general wellbeing during active surveillance, but lifestyle changes are not a substitute for the medical monitoring programme. Follow the surveillance schedule agreed with your specialist team and discuss any supplements, diets or major lifestyle changes with them if you are unsure.
Questions to ask your specialist
- Why are you recommending active surveillance for me?
- How often will I need PSA tests, MRI scans or other checks?
- What changes would make you recommend treatment?
- What are the risks of delaying treatment in my case?
- What treatment options would still be available if the cancer progresses?
- Who should I contact if I become worried between appointments?
This information provides a general introduction to active surveillance for prostate cancer and does not replace advice from your urologist, oncologist or specialist cancer team.