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This leaflet answers common questions about active surveillance of prostate cancer, including why it may be suitable for you, its risks, and its benefits. If you would like further information, or have any worries, please do not hesitate to ask your nurse or doctor.
What is active surveillance of prostate cancer?
Active surveillance is a way of closely monitoring localised (early) prostate cancer, rather than treating it straight away. You might hear it called active monitoring. The advantage of this approach is that you can potentially avoid unnecessary treatment, and its side effects, altogether or delay treatment until a future date.
You will be closely monitored, so if there are signs that the cancer is growing, you will be offered treatment instead. You will only be offered active surveillance as an option if you have a low-risk cancer (known as Gleason 3+3), or an intermediate-risk cancer with favourable characteristics (some Gleason 3+4 cancers).
It might seem strange not to have treatment, but localised prostate cancer often grows slowly – if at all – and has a low risk of spreading. It may never cause you any problems or affect how long you live. Many men on active surveillance will never need treatment, but if you change your mind at any point, you can get in touch to discuss treatment options.
What does active surveillance involve?
When on active surveillance, you will have regular tests to check on the cancer. You won’t have any treatment unless these tests show that your cancer may be growing, or you decide you want treatment.
What are the benefits of active surveillance?
Treatments for prostate cancer, such as surgical removal of the prostate or radiotherapy, can cause side effects which can affect your quality of life. By monitoring the cancer through an active surveillance programme, you can avoid or delay these side effects. The most common side effects of surgical treatment include problems getting and keeping an erection (erectile dysfunction) and problems controlling or passing urine (incontinence). Radiotherapy may cause tiredness, bowel and bladder problems and bleeding.
What are the risks of active surveillance?
There is a small chance that the prostate cancer might grow more quickly than expected and become harder to treat, but this is very uncommon. Studies from the last 10 years have shown a risk of less than 1 in 100 of cancer spreading, or death from prostate cancer, whilst on an active surveillance programme.
It is recommended that some men have a second set of prostate biopsies at some point in the future, which you may not be comfortable with. In addition, your general health could change, which might make some treatments unsuitable for you if you did need them. Some men may worry about not having treatment, and about their cancer growing, but you can change your mind and have treatment instead if this is a problem.
| Advantages | Disadvantages |
|---|---|
| Avoiding side-effects of treatment. | Further biopsies may be necessary in the future. |
| Less interference with everyday life. | Your general health can change, or on rare occasions cancer can grow quickly, meaning that curative treatments may not always be possible. |
| Curative treatments are still possible if required. | Not having treatment can cause anxiety in some men. |
Longer term outcomes
Within 10 years of diagnosis, around a quarter of men will leave active surveillance and undergo treatment to remove the cancer. Some will have treatment because tests show that their cancer has changed, although some men decide that they want to have treatment anyway, even when there is no sign of any change.
What are the alternatives to active surveillance?
The alternative options for localised (early) prostate cancer include:
- Surgery to remove the prostate called a robotic assisted radical prostatectomy (RALP)
- Radiotherapy (where radiation is used to kill cancer cells)
- Brachytherapy (a type of internal radiotherapy)
- Focal therapy (types of therapies which specifically target the cancer and not the whole prostate)
Your doctor or nurse will speak to you about these options as some of them may not be suitable for you.
In the first year after diagnosis
You will have a PSA (prostate-specific antigen) blood test, which helps to detect prostate cancer, every three months, followed by a telephone consultation with a consultant or specialist nurse to discuss the results. It is important that you book a PSA test with your GP or at one of the Royal Free London sites (Barnet Hospital, Chase Farm Hospital, Edgware Community Hospital, Finchley Memorial Hospital, Royal Free Hospital) one to two weeks before each appointment so when you see the doctor or nurse, they will have your result available.
PSA levels vary between patients. Your target PSA level will depend on the size of your prostate and other factors. Your doctor or nurse will discuss this with you during your consultations.
Book a blood test
To book a blood test, please go to the Royal Free London website and search “blood test” or visit www.
Alternatively, telephone: 020 7443 9757 to book a blood test at the Royal Free Hospital, Barnet Hospital, Chase Farm Hospital, or Edgware Community Hospital. For Finchley Memorial Hospital, telephone: 020 8349 7460.
12 months after diagnosis
At 12 months after diagnosis, most patients have a repeat MRI scan of their prostate, unless there is a reason you cannot have an MRI (for example, a pacemaker or extreme claustrophobia).
This is the same as the test which was used to diagnose your cancer in the first instance. The MRI scan and recent PSA blood test results are then discussed in the multi-disciplinary team meeting. You will be contacted following the meeting via telephone with the results and recommendation.
If the scan and blood tests are stable, we will change your follow-up process to remote monitoring every six months, with a PSA blood test required beforehand. This will mean that you will not automatically be given another telephone appointment. If your blood test is stable, you will instead be sent a letter informing you of your results and when your next blood test will be due.
If we have any concerns about your results, you will be booked for an urgent telephone appointment to discuss this with a Clinical Nurse Specialist. For more information on how remote monitoring works, please read our patient information leaflet.
Additional MRI scans and/or prostate biopsies may be carried out in future if necessary.