Active surveillance is a good option for men with early less aggressive disease with few water work symptoms.  As up to 80% of men with PSA screen detected prostate cancer are over treated, it would be a good way to avoid the side effects of interventional treatments such as surgery, brachytherapy and radiotherapy.

There is no hard and fast cut off for recommending active surveillance, this decision is normally made following a detailed and informed discussion with the oncologist.  The factors are more likely to lean the decision towards surveillance are those which relate the disease being unlikely to progress to symptoms during the lifetime of that patient:-

• Less aggressive tumours (low gleason grade)

• Only some amounts of tumour found in the biopsy (low volume disease)

• Low PSA

• Low PSA doubling time

• No urinary symptoms

• Older age

• Poor health

What happens 

Patients are usually seen every three months initially with a rectal examination and a repeat PSA. It is a good idea to calculate the PSAdt each time. If there is evidence of progression on surveillance patients are usually offered treatment.

Lifestyle and active surveillance. There is now emerging evidence that lifestyle factors can alter the rate of progression of indolent prostate cancer and many men are happy to consider these as part of the program. (see lifestyle and prostate cancer).

Historical evidence: 

The concept of active surveillance was formally described for the first time in 2001 by Richard Choo from Toronto, in a report of ‘watchful observation with selective delayed intervention for clinical, histologic, or PSA progression .   Eligibility was restricted to men with clinical stage T1b-T2b disease with a Gleason Score < 7, and initial PSA < 15 ng/ml.   Men were followed every 3 months for the first 2 years and then six-monthly, with digital rectal examination and PSA testing on each visit. Repeat biopsy was performed at 18 months.   Indications for radical treatment were PSA progression, defined as a PSA doubling time < 2 years; histologic progression, defined as upgrading to Gleason score > 8 on re-biopsy; or clinical progression.   The latest update of this study included data on 206 men, with a median initial PSA of 6.5 ng/ml.   At a median follow-up of 29 months, 48 had received curative treatment, 4 had died of unrelated causes, and 154 men remained on observation.

prostate cancer managed by a watch and wait policy (Chodak 1994)

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.