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Active Surveillance

Some men with localised (early stage) prostate cancer may not need to be treated. The cancer will grow so slowly, if at all, that the man will live out his natural span, and die of something else before the cancer causes any symptoms. Results suggest that many men on Active Surveillance will never need treatment for their prostate cancer. Unfortunately, not all early prostate cancers behave like this. Some will progress at a significant rate, so that over a period of years the cancer will grow sufficiently to cause symptoms, and may then spread to other parts of the body and become life-threatening.

Active Surveillance (sometimes called Active Monitoring) is an alternative to immediate treatment. It is a pro-active approach which monitors men with early prostate cancer who do not need immediate curative treatment, so as to spare them the side-effects that may be caused by a treatment that may prove to be unnecessary.

Men on Active Surveillance are closely monitored with a PSA blood test every few months and possibly a repeat biopsy, typically every one or two years. Many doctors now believe that the Free to Total PSA Ratio (see p. 5 and especially prostate MRI scans (see p. 7) are also additional monitoring tools. Those cases that show signs of tumour progression will be advised to receive curative treatment, normally with surgery, radiotherapy or brachytherapy, dependent on age and other factors.

Advantages and disadvantages

Advantages and Disadvantages of Active Surveillance Treatment
Advantages Disadvantages
  • Active Surveillance may avoid unnecessary treatment, with its resultant side effects.
  • It will also give the opportunity for a change of diet and lifestyle which may help in keeping the cancer under control.
  • It can create on-going worry about ‘having cancer’ and ‘doing nothing’.
  • It may mean having repeat biopsies, with their associated risks.
  • Biopsies may not always reveal the extent of the cancer and there is a possibility that you may be harbouring a more significant cancer than the tests indicate.
  • It could happen that the ‘window of opportunity’ for curative treatment may be missed, should the cancer become more aggressive.

Active Surveillance should not be confused with Watchful Waiting. You should check with your consultant that your treatment programme is pro-active, with frequent checks, possible repeat biopsies and other tests, with a view to having curative treatment should it become necessary.

Monitoring your PSA

PSA velocity (the rate at which the PSA increases) and/or doubling time (the period over which the PSA number doubles), together with other factors, play an important part in any Active Surveillance programme, so it is important that you keep a careful record of your PSA results. You have the right, of course, to opt out of Active Surveillance and have treatment at any stage.

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Published: 1-May-13^ back to top