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Prostate Cancer Treatment: What to Know About Active Surveillance

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If you’ve been diagnosed with prostate cancer, your doctor might recommend active surveillance instead of starting treatment right away. This approach may help you avoid prostate cancer treatment side effects if your doctor determines there’s a low enough chance the cancer will cause you symptoms or problems.

Johns Hopkins Medicine pioneered this treatment approach. Here’s what Johns Hopkins urologist Mohamad Allaf, M.D., wants you to know.

Prostate Cancer: When to Treat Versus When to Watch

Because certain prostate cancers grow very slowly, your doctor might determine that it’s not likely to present a significant threat to you. This is particularly true if a prostate cancer is localized, meaning it hasn’t spread beyond the prostate.

If that’s the case, you and your doctor can discuss getting regularly tested instead of undergoing treatment right away. Doctors call this approach active surveillance. By not rushing into treatment for a cancer that may not cause you any harm, this approach helps many men avoid treatment-related side effects.

Active surveillance, or active monitoring, means your doctor will monitor you closely, watching to see how the cancer progresses, if at all. This is primarily for cancers that doctors classify as:

  • Slow-growing
  • Very low risk for causing symptoms

Prostate Cancer Treatment: What Active Surveillance Looks Like

To monitor a low-risk prostate cancer, someone on active surveillance could undergo:

  • Rectal exam: Every six months
  • PSA test: Twice a year. This blood test, commonly used to screen for prostate cancer, measures how much prostate-specific antigen (PSA) is in your blood.
  • Biopsy: Once a year (until and unless your doctor determines a less frequent biopsy is warranted)
  • MRI scan: Necessary in some cases to show more details of a cancer if your doctor has any questions or concerns from your test results

Prostate Cancer Treatment: When Watching May Be Enough

Your doctor will consider many factors before deciding whether this approach is right for you. This includes:

  • Gleason score: This scoring system grades how aggressive a prostate cancer is. It also gives doctors hints as to how likely a cancer is to spread. Gleason scores less than 7 are considered lower risk and might be appropriate for active surveillance.
  • Biopsy results: A prostate biopsy (removing tissue samples from the prostate) is the only definitive way to diagnose prostate cancer today. After a prostate biopsy, your doctor will count how many of the samples contain cancer. For biopsies that show three or fewer samples (or cores) with cancer, your doctor might recommend watching you before starting treatment. 
  • PSA results: A PSA test is the standard way doctors assess prostate cancer risk. Doctors use PSA test results along with information about your prostate size to measure your PSA density. If PSA density is less than 0.15, you might not need treatment right away.
  • Physical characteristics: Another way your doctor will assess prostate cancer is through a rectal exam. If he or she can’t feel a cancer (via a hard nodule, for example), that’s another sign that could point to active surveillance as a possible treatment approach.

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