Doctors often recommend monitoring slow-growing prostate cancer with regular tests instead of starting treatment right away. This is called active surveillance.

Most types of prostate cancer tend to progress slowly, and about 98% of people who receive a diagnosis of this condition will survive.

Treatment can be lifesaving, but it can also cause side effects, such as urinary incontinence or sexual dysfunction. To avoid or delay these side effects, doctors often recommend a practice called active surveillance as a first step for people with low risk prostate cancer.

In simple terms, active surveillance involves visiting your doctor for regular tests to monitor how quickly the cancer is growing before starting treatment.

Read on to learn more about active surveillance for prostate cancer, including when a doctor may recommend it and why it’s important.

Active surveillance is also called expectant management or deferred therapy.

This is when a healthcare team monitors your prostate cancer with tests to see how it changes over time, without administrating any particular treatment.

Your doctor may recommend active surveillance if your cancer is:

  • small
  • not causing symptoms
  • contained to your prostate
  • associated with PSA levels under 10 nanograms per milliliter (ng/mL)
  • expected to grow slowly based on your Gleason score, which is used to classify the grade of prostate cancer cells and refers to how many atypical cells look like cancer and how aggressive their growth seems

In a 2023 study, researchers found that the number of doctors across the United States recommending active surveillance for people with low risk prostate cancer more than doubled from 2014 to 2021, increasing from 26.5–59.6%.

According to the American Cancer Society (ACS), younger males and those with better overall health are less likely to be offered active surveillance. This is because there’s a risk that the cancer could cause concerns many years later.

What is watchful waiting?

A similar concept to active surveillance that doctors sometimes recommend is called watchful waiting.

Watchful waiting involves avoiding treatment until symptoms develop. Treatment is meant to reduce symptoms but not cure the cancer.

Watchful waiting is most often recommended for older men and men with other life threatening health conditions who might not benefit from active treatment.

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Cancer treatment can be life saving, but it can also cause side effects that can impair your quality of life, such as:

Active surveillance can potentially delay or reduce the harmful side effects of cancer treatment without significantly affecting survival.

According to the ACS, men who undergo surgery or radiation therapy don’t seem to live longer than men undergoing active surveillance, but their cancer may spread less or stay in remission longer.

If you’re undergoing active surveillance, you’ll have regular check-ups with your doctor, likely every couple of months. Your doctor will perform a combination of tests to monitor the cancer and see if it’s getting bigger.

According to 2023 research, tests include:

Many people with prostate cancer continue with active surveillance for the rest of their life and never undergo prostate cancer treatment if their cancer doesn’t cause any signs or symptoms.

Your doctor may recommend a biopsy or imaging if they notice changes to the cancer, such as an increase in your PSA levels. Your doctor may recommend starting active treatment if there’s an increase in the size of the cancer or if they notice cancer in multiple parts of the prostate.

In a 2023 study, researchers surveyed an expert panel of healthcare professionals and researchers about the best practices for using active surveillance to manage prostate cancer. The consensus of the panel was that the switch to active treatment could be decided based on:

  • patient preference alone
  • a combination of changes in test results and a conversation with the person with prostate cancer
  • PSA test results alone
  • biopsy results alone
  • MRI-evident changes alone

Prostate cancer typically grows slowly, but some subtypes can be highly aggressive. Your doctor can figure out which type you have by performing tests such as a biopsy, where they look at cancer cells under a microscope.

Active surveillance is recommended as the preferred management technique for low risk prostate cancer by all major clinical guidelines.

In the 2023 research mentioned earlier, researchers looked at recent studies that followed people on active surveillance. The studies reported excellent results with 10-year and 15-year prostate cancer-specific survival rates ranging from 95% to 100% in people with low risk prostate cancer.

In a 2021 study, researchers examined the long-term outcomes of active surveillance for prostate cancer in 2,907 people treated at the Memorial Sloan Kettering Cancer Center from 2000 to 2017.

The researchers found that the probability of being treatment-free at 5, 10, and 15 years for 2,664 men with grade 1 cancer was:

YearsProbability of being treatment-free

Only 5 out of the 2,664 men had cancer that spread to distant parts of their bodies. Spread to distant body parts was only deemed to be preventable in 2 of these cases. Only 1 person died from prostate cancer.

Active surveillance is often recommended for men with prostate cancer that’s considered low risk. It can potentially help delay or avoid prostate cancer treatment side effects that can affect your quality of life.

Whether you decide to undergo active treatment or surveillance is ultimately a personal choice. Some people aren’t comfortable with leaving their cancer untreated, even if it’s expected to grow slowly. Your doctor can help you figure out if you’re somebody who may benefit from active surveillance or if immediate treatment may be the better option.