Active surveillance
Active surveillance is a structured monitoring programme for selected men with prostate cancer that appears less aggressive.
It may be suitable when the cancer is low-risk or favourable intermediate-risk, depending on the PSA, MRI, biopsy findings, cancer volume and patient factors.
Active surveillance does not mean ignoring the cancer. It usually involves regular PSA tests, repeat MRI scans and sometimes further biopsies.
The aim is to avoid or delay treatment side effects in men whose cancer may never cause harm, while still detecting signs of progression early enough to treat if needed.
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What is it?
Active surveillance is careful monitoring of prostate cancer rather than treating it straight away.
It is used when the cancer appears less aggressive and is unlikely to cause harm in the short term. The aim is to avoid or delay treatment side effects while still watching closely for any signs of progression. (Prostate Cancer UK)
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Who is it for?
Active surveillance may suit men with localised prostate cancer that appears low-risk, or sometimes favourable intermediate-risk.
Suitability depends on:
PSA level
MRI findings
Biopsy grade
Amount of cancer found
Prostate size
General health
Patient preference
It is not suitable for every prostate cancer.
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Benefits
Active surveillance may help men avoid or delay the side effects of surgery or radiotherapy.
These side effects can include urinary leakage, erectile dysfunction, bowel symptoms and recovery time.
It also gives time to monitor the cancer properly before committing to treatment.
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Risks
The main risk is that the cancer may grow or become more significant over time.
Some men also find it difficult psychologically to live with untreated cancer.
Active surveillance only works if follow-up is organised and attended. Missed PSA tests, MRI scans or biopsies can make it less safe.
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Before treatment
Before choosing active surveillance, the usual information reviewed includes:
PSA and PSA trend
MRI scan, potentially PSMA scan
Prostate biopsy results
Gleason score / Grade Group
Cancer volume
Clinical stage
General health and life expectancy
Some cases may need discussion in a multidisciplinary team meeting.
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During treatment
Active surveillance usually involves:
Regular PSA blood tests
Clinic review
Repeat MRI scans
Repeat biopsy if needed
The exact schedule varies between hospitals and patient risk.
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After treatment
Active surveillance is ongoing monitoring rather than a treatment with a fixed end point.
If the cancer remains stable, surveillance continues.
If PSA, MRI or biopsy findings suggest progression, active treatment such as surgery or radiotherapy may be discussed.
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Has it worked?
Active surveillance is working when the cancer remains stable.
This is judged by:
PSA pattern
MRI appearances
Repeat biopsy findings where needed
Symptoms, although early prostate cancer often causes none
The goal is to treat only if the cancer starts to show signs that treatment is needed.
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Questions to ask
Is my cancer low-risk or intermediate-risk?
Was the cancer visible on MRI? What about the PSMA scan ?
Are there discprepancies between my biopsies, MRI and PSMA scan ?
How much cancer was found on biopsy?
What is my PSA density?
How often will I need PSA tests?
When would I need another MRI?
Will I need another biopsy?
What changes would trigger treatment?
Would surgery or radiotherapy still be possible later?
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Useful UK based links
NHS prostate cancer treatment information:
https://www.nhs.uk/conditions/prostate-cancer/treatment/
BAUS active surveillance information:
https://www.baus.org.uk/patients/information_leaflets/204/active_surveillance_for_low_to_intermediate_grade_prostate_cancer
Prostate Cancer UK active surveillance:
https://prostatecanceruk.org/prostate-information-and-support/treatments/active-surveillance
NICE prostate cancer guideline:
https://www.nice.org.uk/guidance/ng131
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Need further help?
Private consultations with Mr Anthony Bates are available through Prostatology for raised PSA, MRI review, biopsy results, treatment planning and second opinions.
Book through Prostatology:
https://www.prostatology.co.uk/consultations