Overview

As surprising as it may seem, in some cases, if your cancer is confined within the prostate, your doctor may recommend waiting before you start treatment. He could opt for watchful waiting or active surveillance. There is a difference between the two approaches. Although we will address both approaches, the majority of the information on this page is about active surveillance, a treatment option for localized low-risk prostate cancer.

What is active surveillance?

Active surveillance is a way to monitor a slow-growing prostate cancer instead of treating it right away. The goal is to avoid unnecessary treatments or delay treatment and its possible side effects.

How do you explain this?

Prostate cancer is often slow-growing and can be present for many years and never spread, produce symptoms, or threaten the life of a patient. Active surveillance can be a treatment option if you are diagnosed with a prostate cancer that has a very low risk of progressing.

What is active surveillance?

Active surveillance means the healthcare team watches you closely. Treatment is given if your tumour shows signs of growing or if your cancer shows signs of an increased risk of progression. The term active surveillance gives you the impression that nothing is happening which is not necessarily the case. This is an active method based on closely monitoring your cancer’s progression.

Who can undergo active surveillance?

Active surveillance may be recommended if your cancer is still in its early stages and if it is at a low grade where it grows slowly. In this way, risks of erectile dysfunction and incontinence associated with this treatment can at least be temporarily avoided.

Choice-justifications

Choosing observation depends on a number of factors such as your general health, your age, and your family history. If your doctor feels that your death will be caused by a condition other than prostate cancer, he may recommend observation as your preferred choice of treatment.

This option is also dependent on how aggressive your cancer is. Well-differentiated, low-risk cancers are generally less aggressive and develop more slowly. Thus, you may be offered active surveillance if:

• the cancer is low grade with a Gleason score of 6
• the prostate-specific antigen (PSA) level is less than 10 ng/mL
• the cancer isn’t causing any symptoms
• you prefer not to have treatment right away so you can avoid treatment-related side effects and keep the quality of life that you’re used to

Advantages and limitations

Advantages of active surveillance

• No treatment side effects
• No change to your quality of life

Limitations of active surveillance

• Frequent follow-up visits and tests
• Induces stress and anxiety in many patients
• Natural history of each patient’s cancer can differ

Risks and complications

Although 100% reliable tools are not available to predict disease progression, the risk of progression to a more advanced stage of cancer or the loss of a treatment window is extremely rare because of your close medical follow-ups. Your doctor will start treating you as soon as symptoms or signs appear that your illness is changing. The cure rate remains the same and treatment after active surveillance is no more complicated or does not cause more side effects.

What to expect

Regular tests

Learn

Find out all of your treatment options

Ask your doctors about each choice, including benefits and side effects. Some doctors only suggest the option they know best. Typically:

• a radiation oncologist can discuss active surveillance and radiation treatment.
• a urologist can discuss active surveillance and surgery.

Talk about your choices with these physicians and your family doctor.

What is watchful waiting?

As mentioned at the beginning of this page, watchful waiting is different from active surveillance. Older men or men diagnosed with a slow-growing cancer who are suffering from other more life-threatening diseases will die before cancer poses a threat.

When all signs indicate the cancer is slow growing or that your life expectancy is less than 10 years, the selected course of action may be to wait for symptoms to appear before beginning treatment. This is called watchful waiting. It is important in certain cases to weigh the inconvenience of treatment with the risk posed by the cancer.

This surveillance mode allows initiation of a treatment only when the cancer causes symptoms, in order to treat them. In this case, the goal of any future treatment will not be to cure your cancer, but to control your symptoms. This is called palliative treatment.

If your doctor has suggested watchful waiting, your medical follow-ups will include a PSA test, a physical examination, including a digital rectal examination (DRE), a bone scan or other tests as needed and if your cancer progresses, your doctor will address it. This is a case by case approach.