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Active Surveillance for Prostate Cancer

Active surveillance, also known as watchful waiting, is an approach to prostate cancer treatment that involves monitoring the disease and watching for progression, rather than undergoing surgery or radiation treatment right away. It requires close monitoring of the cancer through frequent physician visits. If the cancer progresses, treatment may be started immediately.

Who is a candidate for active surveillance?

  • Watchful waiting may be a viable option for patients with early-stage prostate cancer, especially elderly patients who have other significant health issues that may worsen the normal side effects of treatment.
  • Patients with low-grade tumors may also consider this approach.
  • If a patient is 75 years or older, has less than 10 years to live, or has a small amount of prostate cancer with a PSA level lower than 10, the risks of prostate cancer treatment may outweigh the benefits.
  • We do not recommend watchful waiting for men who have 'curable' cancer or cancer that could benefit from treatment. We typically advise anyone younger than 75 to have some form of treatment, so long as they are healthy enough to make treatment worthwhile.

What are the risks of active surveillance?

The primary risk is that the cancer will progress to the point that treatment is required or that it spreads and becomes incurable. There is a 10 to 25 percent risk that a low-grade, low-stage prostate cancer tumor will progress within 10 years. Younger patients have a higher risk of developing incurable disease.

Vigilance is necessary with this approach. Patients must commit to frequent screening and biopsies to ensure the cancer hasn't become more aggressive.

What are the benefits of active surveillance?

Most prostate cancers grow slowly, so it's possible that a man undergoing active surveillance will never develop symptoms or require treatment-particularly if he's much older. This means he would avoid the side effects of treatment. There's also the hope that new treatments could become available during the time spent watchful waiting.