Active Surveillance

It is a way of monitoring early stage or slow-growing prostate cancers. It can help avoid or delay radical treatments such as radiotherapy or surgery.

What is active surveillance?

  • This is a way of monitoring early stage or slow-growing prostate cancers. It can help avoid or delay treatments such as radiotherapy or surgery.
  • If your tests show changes, you will be offered treatment that aims to cure your prostate cancer. You can change your mind at any time. Talk to your doctor if you have any concerns about being on active surveillance.
  • Watch our short animation to learn more about active surveillance.

Important things to know

Who can have active surveillance?

Your doctor may recommend active surveillance if:

  • Your prostate cancer is contained within your prostate. This is called localised or early-stage prostate cancer.
  • Your prostate cancer is not likely to cause you any problems within the next few years.

What are the benefits of active surveillance?

  • No treatment side effects.
  • If your cancer starts to grow, you may start treatments that aim to cure your cancer. Although this may not be possible if your general health has got worse.
  • Active surveillance does not interfere with your everyday life.
  • 98 out of 100 people who chose active surveillance were still alive at 10 years.
Overall survival active surveillance
  • This figure is for those with Cambridge Prognostic Group 1, 2 and 3 localised prostate cancer. Ask your doctor or nurse specialist for your grading. Also take a look at our page on the grading and staging of prostate cancer (link will open in a new tab).
  • For more accurate and personalised information on the likely risk and benefit from treatment, you can visit the Predict website (this will open an external tab). This site is best used with the support of a healthcare professional. 

 

Simon AS
"I ended up being Active Surveillance for about 9 years. Overall it was a fairly good journey and like anything around prostate cancer with the regular tests and things you have times of stress but it was manageable".
Simon
Frequently asked questions (FAQs) about active surveillance

The type of tests and how often you have them may differ between hospitals and doctors. But the most common tests are:

 

PSA test

You will have PSA tests more often in the first year. About every three-to-four months. They will then go down to about once every six months. 

 

 

Digital rectal examination

 

You may also have a DRE every year.

 

 

MRI scan

 

 An MRI scan will be offered at 12–18 months. 

 

 

Prostate biopsies

 

If your doctor is concerned with any of your test results, you may need to have another MRI and a prostate biopsy. 

  • If your doctor is concerned that your prostate cancer is changing, they will talk to you about treatments. The treatment choices you have will depend on:
    • Your general health
    • Your age
    • The stage of your cancer.
  • If you have other serious health conditions, you may not be able to have surgery or radiotherapy. 

 

Older White man talking to GP
  • As you are not having any active treatments, you should not have any pain. If you need a prostate biopsy, you may feel some discomfort. 
  • You will need to take time off work for your regular check-ups and tests.

Talk to your doctor if:

 

 

    You start having problems peeing

 

 

 

    You get pain in your bones

 

 

 

    You feel constantly tired and weak

 

 

    

Being on active surveillance makes you feel anxious or worried.

No, your doctor will only talk to you about active treatment if your prostate cancer begins to show changes.

 

Black man and doctor looking at scan
  • You may need to have more prostate biopsies. These can cause side effects. They may also be uncomfortable or painful for some people.
  • If your general health gets worse, you may not be able to have some treatments if you need them e.g. surgery.
  • Your cancer may grow more quickly than expected. But there is only a small chance of this happening.

  • Being on active surveillance can make some people feel anxious. They can worry about their cancer growing. You can always talk about any concerns you have with your doctor or nurse. They can discuss other treatment options with you. 

     

Black man talking to doctor in white coat

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page (this link will open in a new tab).

What is risk?

  • Risk is the chance something bad could happen when we do something. Even simple things such as walking down the stairs can have risks. But we take risks because we think it will be worth it. We need to think about both the benefits and risks of what might happen when we do something.
  • You should always ask your healthcare team about both the benefits and risks of any treatment.
  • Remember if they tell you about a risk, it doesn‘t mean it will happen to you. They may say one man in ten who has this treatment will have a side effect. But they can‘t tell you if you will be the ‘one’ man who gets this side effect.
showing a see saw with risk on one side and benefits on the other
problems peeing
problems pooing

This data is for people with CPG 1, 2 and 3 localised prostate cancer. Click here to learn more about CPG groups (this will open in a new tab).

sexual risks

This data is for people with CPG 1, 2 and 3 localised prostate cancer. Click here to learn more about CPG groups (this will open in a new tab).

  • The information on the risks comes from very large clinical studies. These typically involved thousands of people being watched over many years. 
  • There may be local data from your area. You can ask your healthcare team if they have this information too. 

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page.

What is the impact?

  • We asked real visitors to the infopool to share their experience of this treatment. They told us how this treatment had impacted their everyday lives in a number of different areas.
  • The numbers and images below represent how many people said this treatment had impacted them 'a lot' in each of the different areas.
  • For example, imagine it says ‘25 in 100’ underneath ‘physical and social wellbeing’. This means that 25 out of 100 people who shared their experience of this treatment told us it impacted their ‘physical and social wellbeing’ a lot. However, it would also mean that 75 out of 100 people said it had not impacted them a lot.

Physical and social wellbeing

Enjoying activities such as walking or going out to the pub

53 out of 100

Effect on relationships

Ability to make good connections with others

38 out of 100

Sexual activity

Ability to reach sexual arousal, either physically or emotionally

46 out of 100

Sense of self

Knowing who you are and what motivates you

35 out of 100

Wellbeing and quality of life

Feeling good and functioning well in your personal and professional life

51 out of 100

Mental and emotional health

Ability to think clearly, make good decisions, and cope with your emotions

58 out of 100

Fatigue

Feeling of constant physical and/or mental tiredness or weakness

42 out of 100