Active surveillance is a way of monitoring prostate cancer which aims to avoid unnecessary treatment in men with less aggressive cancer. 

Active surveillance is suitable for men with low risk, early stage prostate cancer. To decide if you are suitable for active surveillance, your urologist will consider:

  • your PSA level
  • your biopsy findings
  • what your prostate feels like during digital rectal examination (DRE)


Active surveillance vs Watchful waiting

Active surveillance and watchful waiting are two ways of monitoring prostate cancer and avoiding immediate treatment.

Watchful waiting involves yearly PSA blood tests with the aim to control the cancer, rather than getting rid of it completely. It is suitable for older men and men who have other health problems where prostate cancer is unlikely to affect their life expectancy.

Active surveillance involves regular tests with the aim to treat to cure the cancer promptly if it shows signs of changing.


Active surveillance tests

  • Prostate specific antigen (PSA) blood test to measure the amount of PSA in your blood.  PSA is a protein produced by your prostate.
  • Digital rectal examination (DRE) where the urologist will feel your prostate gland for changes through the wall of your back passage (rectum).
  • Prostate biopsies involves taking small pieces of prostate tissue.  This is sent to the laboratory to look for signs of prostate cancer.  It will be like the biopsy you had when your cancer was first found.  This may be called a transrectal ultrasound prostate (TRUS) biopsy
  • Saturation grid biopsies are sometimes required if the urologist decides a larger sample of prostate tissue is needed to assist the diagnosis.  This procedure is done under a general anaesthetic.
  • Magnetic resonance imaging (MRI) scans may be undertaken to look for any abnormal areas in the prostate.  This will assist the urologist with their diagnosis. This is only required for a small number of men, particularly if the cancer has been hard to find.

If tests show signs that the cancer is changing, your urologist will discuss with you whether you should have treatment and what your options are.


Active surveillance protocol

Your urologist will follow a strict protocol which is internationally recognised for the safe follow-up of prostate cancer.

PSA: this will be tested 3 monthly for the first year, then 6 monthly for the next 18 months, then yearly thereafter. Your PSA usually fluctuates each time it is tested, but the general trend is more important than each individual value. This is why it is tested regularly to begin with.

TRUS biopsy: repeat biopsies will be recommended after 6 months, again after a further 2 years, again after a further 3 years, then every 5 years thereafter. The reason to repeat the biopsy is to make sure the cancer is not changing.

DRE: your urologist will feel your prostate gland each time you need a repeat biopsy. This is to ensure that there is no obvious sign of growth of the cancer.

AuthorUrology Associates