Active surveillance for prostate cancer

Active surveillance for prostate cancer is used to avoid treatment side effects in men with a very low risk of prostate cancer progression.

Because prostate cancer grows very slowly, men who are diagnosed when the cancer is very small may never have signs and symptoms of the disease. Many may live out their normal life spans before the cancer ever grows large enough to require treatment.

Active surveillance for prostate cancer may be appropriate for you if:

• Your cancer is small. If your cancer is found early, while it's still small and limited to one area of your prostate, active surveillance may be a reasonable choice.
• Your Gleason score is low. Active surveillance may be best suited for men with a low Gleason score (usually 6 or lower), which indicates a less aggressive, slower growing (indolent) form of cancer.
• You have other serious health problems. If you have other advanced health problems, such as severe heart disease, that limit your life expectancy and that could potentially be made worse by treatment of prostate cancer, you may opt for active surveillance.

Risks of active surveillance for prostate cancer include:

• Anxiety. You may be anxious and have a sense of uncertainty about the status of your cancer.
• Frequent medical appointments. Men who choose active surveillance must be willing to meet with their doctors every few months.
• Cancer growth. The cancer can grow and spread while you wait. If cancer spreads, you may miss the window of opportunity for effective treatment.
• Fewer treatment options. If your cancer spreads, you may have fewer options for treatment. Your treatment options may be more drastic than treatments used for very small cancers.

During active surveillance, you'll have regular visits with your doctor to monitor the cancer, usually every few months.

At these visits, your doctor may perform the following tests and procedures:

• Digital rectal exam. During a digital rectal exam, your doctor examines your prostate gland by gently inserting a lubricated, gloved finger into your rectum. Your doctor can feel the surface of the prostate and assess if the cancer has grown.
• PSA blood test. A PSA test measures the amount of prostate-specific antigen (PSA) in your blood. If your PSA rises, it may indicate cancer growth.
• Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create an image of your prostate gland.
• Collection of prostate cells (prostate biopsy). Collecting samples of cells from within your prostate is usually recommended one year after active surveillance begins. Biopsy may be repeated occasionally, as your doctor recommends, to determine how much the cancer has grown and to re-evaluate your Gleason score to see if the cancer remains slow growing.

Many men who choose active surveillance for prostate cancer never undergo prostate cancer treatment. The cancer may never grow, and these men may live out their normal life spans.

But some men may choose to treat their prostate cancer if:

• The cancer begins growing faster than expected
• The cancer spreads outside a confined area within the prostate
• The cancer causes signs and symptoms

Treatment options for prostate cancer depend on your particular situation, but may include surgery, medications and radiation.