Home Oncology Active Surveillance of Prostate Cancer – An overview

Active Surveillance of Prostate Cancer – An overview

Verified By Dr Sanjai Addla April 19, 2021 2214 0
Active Surveillance of Prostate Cancer
Active Surveillance of Prostate Cancer

Active surveillance of prostate cancer is an approach to monitor early or localized prostate cancer. It is about close monitoring instead of getting started with the treatments right away.

The course of active surveillance involves strict monitoring of prostate cancer for changes (if any). This approach is also known as watchful waiting or expectant management.

More About Active Surveillance of Prostate Cancer

When you are under active surveillance, your doctor does not provide you with any cancer treatment. It means he/she does not prescribe any medications, radiation, chemotherapy, or surgery during that period but only recommends periodic tests to understand if your cancer is spreading or growing.

You are likely to consider this process if the cancer is growing slowly, is small, limited to one particular portion of your prostate gland, or not showing any symptoms. Moreover, if you have any underlying health issue that might affect your life expectancy, the active monitoring approach might be a reasonable one.

Are you the right candidate for active surveillance of prostate cancer?

Active monitoring for prostate cancer might be the right approach for you under the following conditions:

  • The extent of cancer is limited or small: If your disease has been diagnosed early (when your cancer is still minute or localized), the active approach might be suitable for you.
  • Your Gleason grade is not alarming: The Gleason grading system is a method that helps understand prostate cancer staging. The scores range from a window of 6 to 10. If your Gleason score is six or less, it indicates that your cancer is indolent (slow-progressing), low grade and less aggressive. In this condition, the active surveillance program might be suitable for you.
  • You have other pre-existing health complications: If you have any other health concerns, like a severe cardiovascular (heart) ailments that might affect your life expectancy, and if prostate cancer treatment could make it worse, active surveillance is a good idea. Make sure to inform your doctor if you have any critical health conditions.

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Why does your doctor recommend active surveillance of prostate cancer?

When the risk of progression of your prostate cancer is low, your doctor is likely to recommend active monitoring to help you avoid the side effects of treatment. Prostate cancer progresses very slowly. Therefore, when your cancer is small, you are less likely to experience any signs or symptoms. Many people lead a normal life (with usual life expectancy) before the disease ever spreads, requiring treatment.

What are the advantages of choosing active surveillance of prostate cancer?

If you are under careful screening, active surveillance can be an advantage. The advantages include:

  • When you are under active monitoring, you do not need any treatment. This way, you can avoid the side effects of cancer treatment.
  • Unlike cancer treatments, this approach will not affect your daily life.
  • As you are under continuous evaluation, your cancer treatment can start immediately if your test reports suggest that the malignancy might be spreading.

 What are the risks of active surveillance for prostate cancer?

The risks of active monitoring for prostate cancer include the following:

  • Stress and anxiety: As the active surveillance phase does not involve any treatment, you might feel worried, apprehensive, and unsure about the progression and stage of the disease.
  • Perioding medical follow-ups: If you choose the active monitoring approach, you should be willing to see your doctor frequently.
  • Progression of cancer: If the active surveillance strategy for prostate cancer is not followed properly, it can result in your cancer advancing and spreading while you are waiting. If the malignancy spreads, you might miss the right phase of effective treatment.
  • Limited treatment options: If your cancer advances while you are under active monitoring, the range of treatment options is likely to be minimized. Also, now your treatments will likely be more extreme than in the early stage of cancer.

What can you expect while under active surveillance of prostate cancer?

When you are under active surveillance of prostate cancer, you will likely make frequent visits to your doctor. The frequency might be once or twice every couple of months.

During these visits, your doctor may conduct the following diagnostic tests and procedures:

  • Digital rectal examination: During this test, your doctor checks your prostate gland through your rectum. While assessing your rectum, he/she can touch the surface of your prostate gland and evaluate the cancer.
  • Ultrasonography: If your doctor suspects anything wrong or your rectal examination suggests metastasis, your doctor is more likely to perform an ultrasound (taking pictures of your internal organs using sound waves) for further evaluation. During ultrasonography, your doctor will insert a tiny probe (resembling a cigar in shape and size) through your rectum to see the images of your prostate gland.
  • MRI (Magnetic Resonance Imaging): If your doctor suspects a progression, he or she might also perform an MRI. This diagnostic procedure takes pictures (cross-sectional) of your prostate gland.
  • Prostate biopsy:  During this procedure, your doctor extracts small batches of tissue from your prostate gland. It is to test the status of your cancer. Your doctor is likely to recommend a biopsy after one year of active monitoring. It helps them evaluate the progression of your cancer and re-evaluate your Gleason grade.


For carefully screened candidates, active surveillance of prostate cancer is the most suitable option. Not only can it help you avoid the side effects of cancer treatment, but you can get started with your treatment the moment your test results suggest cancer progression. However, do not miss your appointments and follow whatever your doctor recommends for a better outlook.

Frequently Asked Questions (FAQs)

1. Does prostate cancer spread slowly? If yes, then how long does it take the malignancy to advance?

Unlike most cancers, prostate cancer happens to advance at a slower rate. Also, it is likely to take around 15 years for prostate cancer to grow and affect the other areas of your body, especially your bones. In many cases, the disease is less likely to interfere with the natural life expectancy.

2. A person’s Gleason score is 8. What does it mean in light of prostate cancer?

Generally, the Gleason grading system uses a score range of 6 to 10. If your score is 6 or less, it means you have low-grade prostate cancer. If your score is 4, it means your cancer is of medium-grade. If your Gleason score ranges from 8 to 10, it indicates you have high-grade cancer, and it is spreading.

3. To which part of your body does prostate cancer spread first?

The lymph nodes surrounding the prostate gland are usually among the first areas to which prostate cancer spreads. If the malignancy has reached your lymph nodes at the time of the diagnosis, it will likely spread to the rest of your body quickly. Therefore, you need to be very careful when you are under active surveillance of prostate cancer.

Verified By Dr Sanjai Addla
MBBS, MRCS, MD, CCT in Urology, FRCS (Urol), Fellowship in Uro-Oncology, Sr Consultant Surgical Uro Oncologist and Robotic Surgeon, Apollo Hospitals, Jubilee Hills, Hyderabad

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