Active surveillance is a plan for prostate cancer that is not growing fast. It can be a choice for you if your cancer is in an early stage. Many people choose this plan so they can avoid or delay treatment. It can reduce the side effects that come with surgery or radiation.

Active surveillance works by checking your prostate cancer on a set schedule. That way, you know if it stays the same or starts to grow. If there is a sign of growth, you and your doctor may switch to treatment. This could be surgery, radiation, or other medical approaches. The main goal is to watch the cancer and act only when needed.

This plan is often suggested for those with low-risk cancer. Low-risk cancer usually has a lower Gleason score. The Gleason score is a scale that helps doctors measure how cancer cells look under a microscope. A lower score means cells look closer to normal. This plan can also be an option for people of an older age group. They may have other medical concerns or a slower-moving tumor. Each person’s path will depend on lab results, exam findings, and personal wishes.

Doctors use certain factors to see if you qualify. They look at your PSA (prostate-specific antigen) levels. PSA is a protein made by cells in the prostate. A lower PSA level can point to a lower chance of fast growth. A higher level can sometimes mean cancer is growing, but not always. Doctors also do a digital rectal exam (DRE). They feel the prostate to see if it has bumps or hard areas. If the prostate feels smooth and has no odd lumps, you may be a candidate for this plan. Doctors also weigh your general health. If you have other issues, it could affect your final decision.

Another important factor is imaging. Some doctors use MRI scans to get a clear picture of the prostate. MRI can show areas that may look suspicious. It can guide where to take biopsy samples. A biopsy is when doctors take small pieces of tissue from your prostate. Lab experts then look at these cells under a microscope. This helps confirm the Gleason score. This is how doctors tell if your cancer is low-risk, medium-risk, or high-risk. People who have low-risk or some forms of medium-risk cancer may choose active surveillance.

It is key to talk with a healthcare provider who knows your medical history. A study in the Journal of Clinical Oncology reported that men with certain low-risk features can do well on active surveillance for many years. That means they had stable PSA levels and no new alarming results on exams. Other research in the Journal of Urology has shown that close monitoring can allow people to avoid treatment for a long time. Still, each person is different, so it is wise to ask questions and gather facts before you decide.

If you are a candidate, your medical team will set a schedule for checkups. These checkups often include PSA tests. You might get these a few times a year or once every six months, based on your situation. DREs may happen on a regular basis, too. MRI scans might be scheduled if there is a rise in PSA or a change on physical exam. A repeat biopsy may also be part of the plan. Some doctors do a biopsy a year or two after the first one. Others may wait longer if lab tests look stable.

This schedule may feel strict. You may wonder why you need so many tests if your cancer is not very aggressive. The reason is to spot changes early. Early changes let you act sooner if the cancer grows. Still, some people find these repeat tests stressful. It is natural to worry about test results, but many doctors say active surveillance can spare you from side effects of treatments that may not be needed right away.

Living with active surveillance can bring up mixed feelings. You may feel relief that you do not have to go through surgery. You may also feel uneasy because the cancer is still there. Some people feel tension before each test or exam. It can help to speak with a counselor or others who have chosen this plan. You can learn how they handle waiting for results. It is common to have questions about your future. A counselor or friend can give support. A medical team member can also answer your questions about each test or exam.

It is sometimes hard for family or friends to understand why you have not done surgery or radiation. They might worry that “waiting” means you are not doing anything. You can share the facts about active surveillance. This plan is not doing nothing. It is a careful approach to a slow-moving cancer. It avoids the possible side effects of treatment, such as changes in sexual function or problems with bladder control. These side effects can happen with surgery or radiation, so it makes sense to wait if the cancer is not growing fast.

At times, you may feel uncertain or stressed. That can happen if you notice a rise in PSA or if a scan seems different than before. These changes do not always mean the cancer is growing fast. Sometimes, lab numbers go up or down for reasons not linked to cancer. Try to stay calm until you speak with your doctor. Some people find it helpful to write down questions before visits. That way, you do not forget them in the exam room.

You may also want to track your PSA levels in a notebook. This can give you a sense of control. Write the date of each test and the result. If you keep a log, you can see if your levels go up slowly or stay the same for a while. If there is a sudden jump, you can ask your doctor what it might mean. Your doctor might suggest an extra MRI or biopsy if results change in a big way.

Another tip is to share your plan with at least one close friend or family member. That person can support you. They can remind you of test days or help distract you if you feel worried. You might also look for a support group. Some hospitals have groups where people talk about living with prostate cancer. Others meet online in a secure video setting. A group can help you feel less alone. Studies in journals like Psycho-Oncology have shown that people with strong support do better in facing worries.

Diet and basic exercise can also help you feel better. A study in the European Urology journal noted that balanced eating and regular physical activity may help you keep a stable weight. Being active in a simple way—like taking walks or doing light exercise—can lower stress. Talk with your doctor before starting any new workouts.

If your test results stay steady, you will keep going with active surveillance. If the cancer starts to grow, your doctor will talk with you about next steps. At that point, many choose surgery or radiation. Some people also consider other treatments based on what their doctor suggests. The choice depends on how much the cancer has changed and your health at that time.

Active surveillance is not for everyone. Some people prefer to treat the cancer right away. They do not want to think about it each time they go in for a test. They feel calmer knowing they did surgery or had radiation. Other people like the idea of waiting until tests show a clear change. They prefer to put off side effects as long as possible. You will know your own mind best. It helps to talk with your doctor about all the angles. You can also ask for a second opinion from another specialist. You might meet with both a surgeon and a radiation doctor to hear their views.

Make sure you ask about any fees linked to extra tests. Insurance may or may not cover everything. Ask about payment plans if needed. Some medical centers have social workers or financial counselors who can help you. They can guide you on ways to handle billing.

It helps to keep a simple file at home with copies of your test results. That way, if you see a new doctor, you have all your records ready to share. Try to bring a notepad to your visits and write down key points. Ask your doctor to speak in simple language if something is confusing. It is your right to understand your plan.

Talking with family can help them accept this watchful approach. You can say, “My doctor and I chose this plan because the cancer grows slowly. I will get regular tests to watch it. If it changes, we will treat it.” Some people find it helps to show family members printed material from medical journals or from official health agencies. That can explain how active surveillance can be safe for those with low-risk cancer. Clear facts can ease some of the fears loved ones might have.

One concern that can arise is the thought, “Am I missing a chance to fix this?” It is normal to think about that. If it worries you, bring it up with your doctor. Ask about the rate of growth in your case. Ask how often they see men switch from watching to treatment. Talk about what signs would lead them to advise you to move to active treatment. A clear plan can bring peace of mind. Also, many doctors have seen that slow-growing cancer often stays at a manageable level for years. New data in top urology journals also point to good outcomes for many who choose active surveillance.

Another concern is intimacy. Living with cancer can affect how you feel about your body. You might wonder if you can still enjoy closeness. Active surveillance itself does not involve immediate treatment. That means side effects like erection problems may not happen right away. Still, stress and worry can lower your interest in sex. Talking with your partner can help. Some people find it helps to discuss these concerns with a counselor. Others find that learning stress management skills makes them feel more at ease.

It is also possible that you may worry about each new PSA test. If this causes a lot of stress, it might help to set limits on how often you think about it. For example, some people decide they will not check their results until the night before their doctor visit. Others open their results right away so they can process them. You might try different approaches to see which helps you feel calmer.

Some doctors also add advanced genetic testing to check your cancer. This may show if you have certain features that predict a higher risk of growth. Ask if that is an option. A study in European Urology showed that these tests can guide decisions about active surveillance. It is a developing area, so you may want to see if your clinic offers such tests.

Sometimes, people feel pressure to pick a treatment right away. That pressure can come from friends, family, or even some doctors. It is your right to look at all options. You can seek advice from more than one cancer specialist. Ask them about benefits and side effects of each approach. You can also ask about success rates. Look for peer-reviewed sources that share data on outcomes. Doctors often have those articles or can direct you to them.

If you move to treatment at a later point, it is usually because tests show changes. That is the main purpose of active surveillance. You watch for changes. This plan can help you avoid or delay side effects while still keeping an eye on the cancer. If a shift happens, your team will guide you through surgery or radiation. Keep in mind that many who start active surveillance never need to shift to treatment, as noted in a paper in the Journal of the National Cancer Institute. Of course, each case is different. Always follow the advice of your personal doctor.

In day-to-day life, you may forget you have prostate cancer. That can be both comforting and odd. At times, a test date will pop up and remind you. Some people mark these test dates on a calendar in a bright color so they do not miss them. Others set phone reminders. When you get used to the schedule, it can feel less stressful.

A few final thoughts: keep open communication with your doctor. Ask direct questions when you need more facts. Think about bringing a family member or friend to your appointments. They can help you remember details. You might also feel calmer with someone by your side. If you feel uneasy between visits, you can call the office and ask your questions. Most doctors would rather hear from you than have you worry in silence.

Active surveillance can be a solid plan for the right person. It takes a bit of patience and a willingness to do periodic tests. It also takes an understanding that you may move to treatment one day. Many find that this plan lets them keep a regular routine for many years. Talk with your doctor about your test results. Ask how your PSA is changing. Bring up any new health issues you notice. That way, you have the facts you need to decide what comes next.

References (peer-reviewed):

  • Tosoian JJ et al. “Active Surveillance Program for Prostate Cancer.” Journal of Clinical Oncology.
  • Klotz L et al. “Clinical Results of Long-Term Follow-Up of a Large, Active Surveillance Cohort with Localized Prostate Cancer.” Journal of Urology.
  • Sanda MG et al. “Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors.” New England Journal of Medicine.
  • National Cancer Institute. “Prostate Cancer Treatment (PDQ®)–Patient Version.”
  • Hamdy FC et al. “10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer.” New England Journal of Medicine.