The concept of active surveillance, or watchful waiting, has increasingly emerged in recent years as a viable option for men who decide not to undergo immediate surgery or radiation therapy.

During active surveillance, prostate cancer is carefully monitored for signs of progression. A PSA blood test and digital rectal exam (DRE) are usually administered periodically along with a repeat biopsy of the prostate at one year and then at specific intervals thereafter. If symptoms develop, or if tests indicate the cancer is growing, treatment might be warranted.

When to Choose Active Surveillance

Current best estimates indicate that many more men are treated for prostate cancer aggressively than is likely necessary to save a life from the disease. The challenge has been to identify those men who do not need immediate therapy, which is usually decided based on age, co morbidities, and cancer factors like the PSA, stage, amount of cancer in the biopsy, and Gleason grade. Research is ongoing to develop biomarkers and additional tests that can better risk stratify men so that this decision is easier and more accurately informed.

Today, the healthy man who is ideal for active surveillance has a low grade (Gleason 6 or under), low-risk prostate cancer (low PSA and stage), that appears to be low in volume (small amount of cancer found on biopsy, for example), and who is not eager to undergo therapy right away due to concerns about potency preservation or urinary symptoms.

Active surveillance might also be a good choice for older men with limited life expectancy. In addition, if a man is currently battling other serious disorders or diseases, such as heart disease, long-standing high blood pressure, or poorly controlled diabetes, his doctors might feel it is in his best interest to hold off on therapy and avoid its potential complications.

That's because many of the treatment options for prostate cancer can be difficult to endure, and better outcomes are seen in men who are otherwise healthy.

Individual Decisions

The right age for active surveillance is a difficult question, as clearly younger men will live longer with their cancers, and thus have a higher likelihood that their cancer could progress. This decision is best made with your doctors on an individual basis, and hopefully clinical trials will provide more guidance for this in the future. In any case, you should be followed closely over time to make sure that if your cancer does progress, it will still be caught early.