Active Surveillance / Expectant Management

You may have heard that “most people die with prostate cancer and not from prostate cancer.” While that is partly due to improvements in earlier detection and treatments, certain prostate cancers are not life-threatening. With active surveillance, the urologist can monitor prostate cancer by closely following PSA levels, performing a digital rectal exam and likely repeating biopsies periodically to make sure the cancer has not become more aggressive.

A magnetic resonance imaging (MRI) scan and/or other new molecular testing may be undertaken in select circumstances. If cancer shows signs of progression, intervention and active treatment may be begin. Low-risk cancer patients and/or those patients who have other medical problems with shorter life expectancies are the best candidates for active surveillance. African-American patients are at higher risk for more aggressive prostate cancers and may not always be ideal candidates for active surveillance.

Advantages: Avoids or at least postpones the side effects of therapy such as erectile dysfunction and urinary problems to maintain quality of life.

Disadvantages: There is no way to predict with certainty which cancers are not life-threatening. Therefore, there is a risk the cancer can progress at some point to an incurable stage. In other words, there is a chance of missed opportunity for cure. Also, future treatment can potentially be more challenging after multiple prostate biopsies, which are necessary during surveillance monitoring, and more advanced tumors can be more challenging to treat or cure. Also, some patients experience more anxiety living with an untreated cancer.