Active Surveillance

What is Active Surveillance?

Active surveillance involves monitoring your prostate cancer closely. A responsible program of active surveillance may include:
  • Regular prostate specific antigen (PSA) tests and digital rectal exams (DRE)
  • Monitoring PSA doubling time (which may mean having a PSA test every 3 to 6 months)
    • PSA doubling time estimates how long it will take for a man’s level of prostate-specific antigen to double
  • Occasional repeat biopsies 
  • Follow-up bone scan and / or CT scan to monitor disease progression
You will be offered more aggressive treatment at the first sign your prostate cancer has progressed or tumour has grown. 
Watchful Waiting vs. Active Surveillance

The terms ‘active surveillance’ and ‘watchful waiting’ are often used interchangeably, but it is important to know the differences between the two. Watchful waiting involves having no treatment for your prostate cancer. Rather than treating the prostate cancer, your physician will wait until you start having symptoms and treat those, usually with medication. The goal of watchful waiting is not to cure your prostate cancer, but treat your symptoms to make you feel better. With active surveillance, you will monitor the disease closely and have treatment options presented to you when the disease begins to progress.  

Why Choose Active Surveillance?

Some prostate cancers can be relatively slow to grow and spread, and some men are fairly elderly when their prostate cancer is diagnosed. Combine these tendencies with improvements in our ability to monitor prostate cancer growth and with the risk of experiencing side effects from more aggressive treatments, and you can see why, sometimes, active surveillance makes sense. In addition, some men already suffer from other more serious medical conditions. These men are likely to have their lifespan influenced more by their other medical conditions than their prostate cancer.  

Factors in Choosing Active Surveillance

Active surveillance might be recommended to you if:
  • Your prostate cancer is small and appears to be slow-growing and composed of relatively normal-looking cells (this is determined by the pathologist from the prostate biopsy); 
  • You are likely to die from other causes (including old age) before your prostate cancer is likely to create problems for you;
  • You and your physician decide that the possible side effects of more aggressive treatment outweigh the benefits of treatment.
What are the advantages and disadvantages of Active Surveillance?
Deciding if active surveillance is right for you is a decision you should make after knowing the advantages and disadvantages and discussing them with your doctor.

Advantages of Active Surveillance Disadvantages of Active Surveillance
No invasive procedures No side effects from treatment
No drugs Not a cure


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