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Active Surveillance for Prostate Cancer

Prostate cancer is the most prevalent type of male cancer, but some prostate cancers grow so slowly that they may not be life threatening. Studies suggest that 30-50% of men over the age of 60 years diagnosed with prostate cancer today by PSA screening undergo a treatment that will not extend their life or improve its quality. This does not mean that prostate cancer does not kill men, but rather that some men who are older and/or in poor health with a slowly progressive form of the disease, may not need immediate treatment. The aim of active surveillance is to avoid invasive treatment or delay it until there is evidence that the cancer is progressing at a rate that may be life threatening. Men who elect for active surveillance will need to comply with regular visits to a prostate cancer specialist, i.e. a Urologist or Oncologist, as they will need to be monitored very carefully to detect evidence of cancer progression.

Low risk Prostate Cancer

  • Life expectancy less than 10-15 years.
  • Cancer not felt on digital rectal examination and/or small nodule (stage T1c or T2a).
  • PSA below 10ng/ml.
  • Gleason score is 6 or less with no Gleason pattern 4 or 5 on at least a 12 core biopsy.

Many men diagnosed with low-risk prostate cancer are eligible for active surveillance. This term implies careful observation of the tumour over time, with the intention of using curative treatment only if there are signs of cancer progression. Active surveillance must be distinguished form watchful waiting, an older term which implies no treatment or specific program of monitoring, with the assumption that palliative, not curative, treatment would be used if advanced or symptomatic disease develops.

Active surveillance involves monitoring the tumour for signs of growth or the appearance of symptoms. The monitoring process involves regular 3-6 monthly PSA tests, and periodic MRI scans and/or repeated biopsies. The goal of active surveillance is to avoid unnecessary treatment for a non-life-threatening cancer but at the same time to detect any significant cancer progression at stage when the cancer is still curable.

This approach is not used for aggressive cancers, but it may cause anxiety for people who wrongly believe that all cancer is deadly or themselves to have a life-threatening cancer.


This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.

Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.