Active Surveillance: Keeping Watch on Prostate Cancer

For many patients diagnosed with a disease, their first instinct may be to treat it with medications, surgery or some other therapy. If you have slow-growing prostate cancer, however, not treating the disease — at least, not yet — may make the most sense. In partnership with your urology specialist and primary care provider, you may choose a strategy of active surveillance, which calls for regular tests to monitor the cancer’s progression.

“For some men with prostate cancer, the disease grows so slowly that it doesn’t cause symptoms and may never pose a serious threat to their health,” says Matthew Baker, pharmacist and certified physician assistant at Beaufort Memorial Urology Specialists. “On the other hand, treatments such as surgery and radiation therapy may cure the disease, but they can also cause side effects that reduce your quality of life. If you have slow-growing prostate cancer, it’s important to weigh the risks and benefits of treating it with your medical providers. They can help you decide whether active surveillance is right for you.”

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When Do Providers Use Active Surveillance?

Your urology specialist will consider a variety of factors to determine whether you’re a candidate for active surveillance (sometimes called expectant management). First, active surveillance is most appropriate for localized prostate cancer — cancer that hasn’t spread beyond the prostate — that isn’t causing symptoms and seems likely to increase slowly.

Your provider will also factor in your age and other health problems you have. Active surveillance may be a good choice if you’re older or have other medical conditions.

“Choosing active surveillance doesn’t mean doing nothing,” Baker says. “Your health care provider will keep a close eye on the cancer using prostate-specific antigen [PSA] blood tests and digital rectal exams.”

Your provider will determine how often to evaluate your cancer. Typically, though, men receiving active surveillance get a PSA test every six months and an annual digital rectal exam, according to the American Cancer Society. You may also need prostate biopsies and imaging exams at least every three years.

“If the cancer’s status doesn’t change, you may be able to continue active surveillance and avoid treatment — and side effects, such as urinary incontinence or erectile dysfunction, that may follow,” Baker says. “You may need to stop active surveillance and start treatment if your PSA levels or other test results show the cancer growing faster.”

Read More: Prostate Cancer in African American Men: Early Detection Is Key

Active Surveillance vs. Watchful Waiting

When researching or discussing prostate cancer treatment options with your medical provider, you may come across a term associated with active surveillance: watchful waiting. Also known as observation, watchful waiting is, essentially, a less rigorous form of active surveillance. As with active surveillance, watchful waiting may be a good option for small, slow-growing prostate cancers, especially in older men with significant health problems.

“With watchful waiting, you’ll have periodic tests to check the status of the prostate cancer, but they won’t be as frequent as with active surveillance,” Baker says. “Your urology specialist will pay particularly close attention to whether new symptoms develop or existing ones worsen. A change in symptoms may be a sign you need to start treatment.”

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The Limits of Close Monitoring

Active surveillance emerged as an option for men with prostate cancer during the past 10 to 12 years, and its use has soared. From 2014 to 2021, the percentage of men with low-risk prostate cancer receiving active surveillance more than doubled, reaching nearly 60%. As a result, many men may have been able to avoid cancer treatment-related side effects.

Still, despite being safe, active surveillance does carry potential drawbacks. If, for example, a cancer that was expected to grow slowly starts progressing quickly, treating it may be more complicated than it would have been right after it was diagnosed. Plus, active surveillance takes commitment. You’ll need to adhere to the testing schedule your urology specialist sets, which may continue for years.

“Choosing the most appropriate course of action after a prostate cancer diagnosis can be difficult,” Baker says. “Fortunately, you don’t have to decide alone. Your medical team can help you understand your options and how to move forward. If frequent monitoring is the right approach, you can rest assured that your providers will watch the cancer carefully and be ready to adjust course if it changes.”

Need someone who can answer questions about a cancer treatment plan, coordinate medical appointments and connect you with helpful resources? Find a cancer nurse navigator at Beaufort Memorial.