Active Surveillance

Active surveillance, which has been called observation or "watchful waiting," is sometimes the most appropriate medical approach to cancer of the prostate. Why? Prostate cancer can be (but is not always) relatively slow to grow and spread, and men are frequently (but again not always) fairly elderly when their prostate cancer is diagnosed. Combine these tendencies with improvements in our ability to monitor prostate cancer growth, on the one hand, and with the risk of experiencing side effects from more aggressive treatments, on the other, and you can see why, sometimes, active surveillance makes sense.

A responsible program of active surveillance will include regular PSA tests and digital rectal exams. A useful monitoring tool is PSA doubling time, which estimates how long it will take for a man's level of prostate-specific antigen to double. Doctors assessing PSA doubling time may ask a prostate cancer patient to have a PSA test every three to four months. Physicians also may ask for continued biopsies and analysis of the urine to try to monitor your cancer. Note, however, that no monitoring system is infallible. Even biopsies can miss signs of prostate cancer progression.

Men who decide upon active surveillance frequently take on the responsibility of improving their general health by making lifestyle and dietary changes. They may also investigate complementary treatments. It is important to remember, though, that active surveillance may not be appropriate for you and that it should not be undertaken to avoid or postpone more aggressive therapies if these are available to you and needed to fight prostate cancer that puts you at risk.


From G. L. Lu-Yao and S. L. Yao, "Population based study of long term survival in patients with clinically localised prostate cancer," Lancet, 349 (1997): 906-910.

FACTORS IN CHOOSING ACTIVE SURVEILLANCE

Active surveillance might be recommended to you if

• You are likely to die from other causes (including old age) before your prostate cancer is likely to create problems for you;
• If your prostate cancer is small and appears to be slow growing and composed of well-differentiated cells (cells that are relatively normal looking); or
• If you feel that risking the possible side effects of more aggressive treatment is unacceptable and refuse other options.

Related information: "Goodbye Watchful Waiting. Hello Active Surveillance," CPCN, Canadian Prostate Health Council, Watchful Waiting: A treatment option for prostate cancer, CPHC Online Pamphlet, Conseil canadien sur les maladie de la prostate, Attente sous surveillance: Une option thérapeutique dans les cas de cancer de la prostate, CPHC Online Pamphlet, G. W. Chodak and K. S. Warren, "Watchful waiting for prostate cancer; A review article," Prostate Cancer and Prostatic Diseases, 9 (2006), 25-29 D. Robert Siemens, "Radical prostatectomy or watchful waiting in early prostate cancer?" Canadian Medical Association Journal, 168 (January 7, 2003): 1. C. Parker, "Active surveillance of early prostate cancer: rationale, initial results and future developments," Prostate Cancer and Prostatic Diseases, 7 (2004): 184-187.