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Prostate Cancer: Should I Choose Active Surveillance?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate Cancer: Should I Choose Active Surveillance?

Get the facts

Your options

  • Use active surveillance. This means following a schedule of regular checkups and tests.
  • Have surgery or radiation instead of using active surveillance.

This decision aid is only for men who have low-risk localized prostate cancer. Active surveillance is not an option for other types of prostate cancer.

If you have localized prostate cancer and already know that active surveillance is not for you, you may need to decide between surgery or radiation.

Key points to remember

  • With active surveillance, you can choose to wait to start other treatment, such as surgery or radiation. Some men will never need more treatment. And others can delay having treatments until tests show that their cancer is growing or spreading.
  • Surgery and radiation can cause serious side effects, such as erection, bladder, and bowel problems. And these can have a big impact on your quality of life.
  • Surgery or radiation can get rid of the cancer right away. But in many cases, the cancer would never have caused you problems. And having these treatments may not cure the cancer.
  • There is a chance that your prostate cancer may grow or spread during active surveillance. But you will have frequent checkups and tests to watch for any changes.
  • For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance, surgery, and radiation offer about the same chance of survival.1, 2
  • No matter what approach they choose, men with a slow-growing prostate cancer are more likely to die of another health problem than of prostate cancer.1, 2
  • Some men may have a hard time waiting to see if their prostate cancer will need treatment. If you choose active surveillance, having a doctor who supports your choice is important. So is the support of others who are close to you.
FAQs

What is low-risk localized prostate cancer?

Prostate cancer is the abnormal growth of cells in the prostate. Low-risk localized prostate cancer grows slowly and hasn't spread outside the prostate.

Your prostate cancer is considered low-risk if you have early-stage disease, a PSA level less than 10 nanograms per milliliter (ng/mL), a Gleason score of 6 or lower, and no symptoms.

Unlike many other cancers, prostate cancer is usually slow-growing. For most men, this slow growth means they have time to learn all they can before they decide whether to have treatment or which treatment to have. The main treatment options for men with low-risk localized prostate cancer are active surveillance, surgery, and radiation.

Most men who get prostate cancer don't die from it.

What is active surveillance?

Active surveillance means that you will be watched closely by your doctor. You won't have further treatment unless the cancer starts to grow or spread. If this happens, your doctor may recommend other treatment, such as surgery or radiation.

During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests. These include PSA (prostate-specific antigen) tests, digital rectal exams, and prostate biopsies.

Active surveillance is different from watchful waiting. Watchful waiting also means that you'll be watched closely by your doctor. But the goal of watchful waiting is to only treat symptoms that bother you rather than cure the cancer. Men who are near the end of their lives and men who have other serious medical conditions and aren't well enough to have surgery or radiation often choose watchful waiting.

For some men whose cancer is low-grade or slow-growing, active surveillance may be a better treatment option than surgery or radiation. Whether active surveillance is a good choice for you is something you will want to discuss with your doctor. You and your doctor will want to consider:

  • Your age and how long you expect to live.
  • Your PSA level.
  • Your Gleason score. This is based on the type of cancer cells you have.
  • How far your cancer has spread. This is called the stage of your cancer.
  • The side effects you might have from other treatments.
  • Your personal feelings and concerns.

Some men may have a hard time waiting to see if their prostate cancer will need treatment. If you choose active surveillance, having a doctor who supports your choice is important. So is the support of others who are close to you.

What are the benefits of active surveillance?

One of the benefits of active surveillance is that you may be able to avoid treating a cancer that may never be a problem. You also can delay or avoid surgery or radiation and its side effects.

Another benefit is that you can keep your current quality of life and keep doing the activities you enjoy, at least for a time. Your overall well-being; your physical, mental, and sexual health; and your relationships are all part of your quality of life.

For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance offers them about as good a chance of survival as surgery or radiation.1, 2

What are the risks of active surveillance?

There is a chance that your prostate cancer will grow or spread during active surveillance. If this happens, your doctor may recommend other treatment, such as surgery or radiation.

If you choose active surveillance, it's very important to follow your doctor's schedule of tests and exams. Regular checkups will increase your chances of finding out right away if your prostate cancer grows or spreads. That way your cancer still can be treated in the early stages, when treatments are more successful.

It can be hard to wait to see if your prostate cancer will need treatment. Or you may worry that the cancer might get worse between checkups. Not knowing what might happen may affect your quality of life.

What do the numbers tell us about the benefits and risks of active surveillance?

Deaths from prostate cancer or treatment*
Active surveillance Surgery Radiation
Death from prostate cancer or treatment within 8 to 10 years 4 to 8 out of 100 men 6 out of 100 men 3 out of 100 men

*Based on the best available evidence (evidence quality: borderline to moderate).

Risk of erection and bladder problems*
Problems men had 2 to 3 years after starting surveillance or other treatment Active surveillance Surgery Radiation
Erection problems 44 to 47 out of 100 men 81 out of 100 men 59 out of 100 men
Bladder problems 2 to 6 out of 100 men 17 out of 100 men 17 out of 100 men

*Based on the best available evidence (evidence quality: borderline to moderate).

Men who left active surveillance*
Men who left active surveillance within 10 years to have other treatment, such as surgery or radiation, because of signs of cancer growth or spread or for other reasons. 33 out of 100 men

*Based on the best available evidence (evidence quality: borderline).

Benefits

The quality of the evidence about the benefits of active surveillance is borderline to moderate.

Survival

For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance offers them about as good a chance of survival as surgery or radiation.

Take a group of 100 men 8 to 10 years after diagnosis.

  • 4 to 8 out of 100 men on active surveillance died from their cancer or its treatment. This means that 92 to 96 out of 100 did not.
  • 6 out of 100 men who had surgery died from their cancer or its treatment. This means that 94 out of 100 did not.
  • 3 out of 100 men who had radiation died from their cancer or its treatment. This means that 97 out of 100 did not.

These numbers are close enough that experts believe they don't clearly prove that surgery or radiation is a better treatment choice than active surveillance.

Fewer erection problems

Men on active surveillance have fewer erection problems than men who have surgery or radiation.

Take a group of 100 men 2 to 3 years after starting treatment.

  • 44 to 47 out of 100 men on active surveillance had erection problems. This means that 53 to 56 out of 100 did not.
  • 81 out of 100 men who had surgery had erection problems. This means that 19 out of 100 did not.
  • 59 out of 100 men who had radiation had erection problems. This means that 41 out of 100 did not.
Fewer bladder problems

Men on active surveillance have fewer bladder problems than men who have surgery or radiation.

Take a group of 100 men 2 to 3 years after starting treatment.

  • 2 to 6 out of 100 men on active surveillance had bladder problems. This means that 94 to 98 out of 100 did not.
  • 17 out of 100 men who had surgery had bladder problems. This means that 83 out of 100 did not.
  • 17 out of 100 men who had radiation had bladder problems. This means that 83 out of 100 did not.

Risks

The quality of the evidence about the risks of active surveillance is borderline.

There is a chance that your prostate cancer will grow or spread during active surveillance. If this happens, your doctor may recommend other treatment, such as surgery or radiation.

Take a group of 100 men who chose active surveillance.

  • Within 10 years after starting active surveillance, about 33 out of 100 men had other treatment, such as surgery or radiation. This means that about 67 out of 100 did not. Most of these men left because there were signs that their cancer grew or spread. Some left for other reasons.

Keep in mind that the risk that your cancer might get worse may not be the same as someone else's risk. To find out the risk that your cancer might get worse, your doctor will look at your biopsy results, your Gleason score, your PSA levels, the stage of your cancer, and other factors.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.2, 1, 3, 4 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Why might your doctor recommend active surveillance?

Your doctor might recommend active surveillance if:

  • Your cancer is slow-growing and hasn't spread outside the prostate.
  • Your age and current health make you a good candidate for active surveillance.
  • You want to delay or avoid surgery or radiation and its side effects.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Use active surveillanceUse active surveillance
  • You will have regular checkups and tests (including prostate biopsies) to watch for any changes in your cancer.
  • If your cancer grows, you will need to have surgery or radiation.
  • You can delay or avoid surgery or radiation and its side effects.
  • Active surveillance offers about as good a chance of survival as surgery or radiation.1, 2
  • You can keep your current quality of life and continue your normal activities.
  • You can decide later if you want to have surgery or radiation.
  • The cancer may grow or spread during active surveillance.
  • Risks of prostate biopsies include bleeding and infection.
  • You may worry that the cancer might get worse between checkups.
Have surgery or radiation instead of active surveillanceHave surgery or radiation instead of active surveillance
  • You will have surgery or radiation to get rid of the cancer.
  • After surgery or radiation, you will have regular checkups to make sure the cancer hasn't come back.
  • You treat the cancer right away.
  • Surgery or radiation offers about as good a chance of survival as active surveillance.1, 2
  • The cancer could come back.
  • Surgery and radiation have serious side effects, such as erection, bladder, and bowel problems.
  • Risks of major surgery include bleeding, infection, blood clots, problems from anesthesia, and possibly death.
  • Risks of radiation include skin changes (dry, itchy, red skin with peeling or blistering), diarrhea or rectal pain, fatigue, and pain or burning when urinating.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about considering active surveillance

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

When I found out I had prostate cancer, I was scared. My first thought was, "Get it out, now!" But my doctor said that with frequent checkups, I could wait to have surgery, and that I may never even need surgery. After a lot of thought, I decided to wait. I decided that the best way for me to deal with the stress of waiting was to focus on taking better care of myself. So now I'm at the gym 4 times a week, eating a healthier diet, and making sure I get good sleep. I'm also doing more of the things I enjoy, like going fishing with my grandson. And so far, so good. It's been 3 years since I was diagnosed, and I'm doing great.

Alex, 72

I'm not a patient man. If something needs to be done or taken care of, I don't wait. So when my doctor told me I had prostate cancer, there was no question in my mind that I wanted to treat it right away. For me, waiting to see what might happen wasn't an option—even though my doctor said that it was. I was told about all the possible side effects of surgery, which weren't pleasant and certainly not something I was looking forward to. But I decided that dealing with the side effects would be easier than dealing with the anxiety of knowing that my cancer could grow or spread at any time if I waited. I just knew that I couldn't live with that uncertainty.

Ralph, 64

If anyone would have told me that I would get prostate cancer someday, let alone have to decide what to do about it, I would have said that it could never happen to me. But it did. My doctor told me that my chances for survival were about the same no matter which treatment I chose. And he suggested I try active surveillance. At first I wasn't sure about waiting. But my brother-in-law told me about the problems he's had since his prostate surgery. After talking about it with my family, I decided to wait. I know that I still might need to have surgery or radiation someday, but the longer I can put off the side effects of these other treatments, the better.

Darnell, 75

Once I got over the shock of being diagnosed with prostate cancer, I had to decide what to do next. I was really anxious about making the right decision, because the only person I knew who had prostate cancer died from it. And I didn't want that to happen to me. I grappled with the idea of waiting to have surgery. This seemed like a reasonable option since my cancer was small and hadn't spread. But knowing there was a chance that it could get bigger or spread during this time made me nervous. I knew if that were to happen, I would regret not having done something more aggressive from the start. So I decided to have surgery. I know that even with surgery there isn't any guarantee that my cancer won't come back. But at least for now, I'm cancer-free.

Rodney, 67

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to use active surveillance

Reasons not to use active surveillance

I want to avoid surgery or radiation for as long as I can.

I want to get rid of my cancer right away.

More important
Equally important
More important

I'm willing to take the risk that the cancer will grow or spread.

I'm worried that if I wait to have surgery or radiation, my cancer will grow or spread.

More important
Equally important
More important

I'm worried that I might not be able to deal with the side effects of surgery or radiation.

I'm willing to deal with the side effects of surgery or radiation.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using active surveillance

Having surgery or radiation instead of using active surveillance

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Will all men with prostate cancer need surgery or radiation?

  • Yes No, that's not right. A study shows that about 67 out of 100 men still did not need other treatment, such as surgery or radiation, within 10 years after starting active surveillance.
  • No Yes, that's right. A study shows that about 67 out of 100 men on active surveillance still did not need other treatment, such as surgery or radiation, within 10 years after starting active surveillance.
  • I'm not sure It may help to go back and read "Get the Facts." A study shows that about 67 out of 100 men on active surveillance still did not need other treatment, such as surgery or radiation, within 10 years after starting active surveillance.
2.

During active surveillance, do you need to have regular checkups and tests?

  • Yes You're right. During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests, such as PSA (prostate-specific antigen) tests, digital rectal exams, and prostate biopsies.
  • No Sorry, that's not right. During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests, such as PSA (prostate-specific antigen) tests, digital rectal exams, and prostate biopsies.
  • I'm not sure It may help to go back and read "Get the Facts." During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests, such as PSA (prostate-specific antigen) tests, digital rectal exams, and prostate biopsies.
3.

Does active surveillance offer you about the same chance of survival as surgery or radiation?

  • Yes That's right. For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance, surgery, and radiation offer about the same chance of survival.
  • No That's not right. For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance, surgery, and radiation offer about the same chance of survival.
  • I'm not sure. It may help to go back and read "Get the Facts." For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance, surgery, and radiation offer about the same chance of survival.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology

References
Citations
  1. Lu-Yao GL, et al. (2010). Outcomes of localized prostate cancer following conservative management. JAMA, 302(11): 1202–1209.
  2. Wilt TJ, et al. (2012). Radical prostatectomy versus observation for localized prostate cancer. New England Journal of Medicine, 367(3): 203–213.
  3. Chou R, et al. (2011). Screening for prostate cancer: A review of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 155(11): 762–771.
  4. Klotz L, et al. (2010). Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. Journal of Clinical Oncology, 28(1): 126–131.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate Cancer: Should I Choose Active Surveillance?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Use active surveillance. This means following a schedule of regular checkups and tests.
  • Have surgery or radiation instead of using active surveillance.

This decision aid is only for men who have low-risk localized prostate cancer. Active surveillance is not an option for other types of prostate cancer.

If you have localized prostate cancer and already know that active surveillance is not for you, you may need to decide between surgery or radiation.

Key points to remember

  • With active surveillance, you can choose to wait to start other treatment, such as surgery or radiation. Some men will never need more treatment. And others can delay having treatments until tests show that their cancer is growing or spreading.
  • Surgery and radiation can cause serious side effects, such as erection, bladder, and bowel problems. And these can have a big impact on your quality of life.
  • Surgery or radiation can get rid of the cancer right away. But in many cases, the cancer would never have caused you problems. And having these treatments may not cure the cancer.
  • There is a chance that your prostate cancer may grow or spread during active surveillance. But you will have frequent checkups and tests to watch for any changes.
  • For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance, surgery, and radiation offer about the same chance of survival.1, 2
  • No matter what approach they choose, men with a slow-growing prostate cancer are more likely to die of another health problem than of prostate cancer.1, 2
  • Some men may have a hard time waiting to see if their prostate cancer will need treatment. If you choose active surveillance, having a doctor who supports your choice is important. So is the support of others who are close to you.
FAQs

What is low-risk localized prostate cancer?

Prostate cancer is the abnormal growth of cells in the prostate . Low-risk localized prostate cancer grows slowly and hasn't spread outside the prostate.

Your prostate cancer is considered low-risk if you have early-stage disease, a PSA level less than 10 nanograms per milliliter (ng/mL), a Gleason score of 6 or lower, and no symptoms.

Unlike many other cancers, prostate cancer is usually slow-growing. For most men, this slow growth means they have time to learn all they can before they decide whether to have treatment or which treatment to have. The main treatment options for men with low-risk localized prostate cancer are active surveillance, surgery, and radiation.

Most men who get prostate cancer don't die from it.

What is active surveillance?

Active surveillance means that you will be watched closely by your doctor. You won't have further treatment unless the cancer starts to grow or spread. If this happens, your doctor may recommend other treatment, such as surgery or radiation.

During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests. These include PSA (prostate-specific antigen) tests, digital rectal exams, and prostate biopsies.

Active surveillance is different from watchful waiting. Watchful waiting also means that you'll be watched closely by your doctor. But the goal of watchful waiting is to only treat symptoms that bother you rather than cure the cancer. Men who are near the end of their lives and men who have other serious medical conditions and aren't well enough to have surgery or radiation often choose watchful waiting.

For some men whose cancer is low-grade or slow-growing, active surveillance may be a better treatment option than surgery or radiation. Whether active surveillance is a good choice for you is something you will want to discuss with your doctor. You and your doctor will want to consider:

  • Your age and how long you expect to live.
  • Your PSA level.
  • Your Gleason score. This is based on the type of cancer cells you have.
  • How far your cancer has spread. This is called the stage of your cancer.
  • The side effects you might have from other treatments.
  • Your personal feelings and concerns.

Some men may have a hard time waiting to see if their prostate cancer will need treatment. If you choose active surveillance, having a doctor who supports your choice is important. So is the support of others who are close to you.

What are the benefits of active surveillance?

One of the benefits of active surveillance is that you may be able to avoid treating a cancer that may never be a problem. You also can delay or avoid surgery or radiation and its side effects.

Another benefit is that you can keep your current quality of life and keep doing the activities you enjoy, at least for a time. Your overall well-being; your physical, mental, and sexual health; and your relationships are all part of your quality of life.

For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance offers them about as good a chance of survival as surgery or radiation.1, 2

What are the risks of active surveillance?

There is a chance that your prostate cancer will grow or spread during active surveillance. If this happens, your doctor may recommend other treatment, such as surgery or radiation.

If you choose active surveillance, it's very important to follow your doctor's schedule of tests and exams. Regular checkups will increase your chances of finding out right away if your prostate cancer grows or spreads. That way your cancer still can be treated in the early stages, when treatments are more successful.

It can be hard to wait to see if your prostate cancer will need treatment. Or you may worry that the cancer might get worse between checkups. Not knowing what might happen may affect your quality of life.

What do the numbers tell us about the benefits and risks of active surveillance?

Deaths from prostate cancer or treatment*
Active surveillance Surgery Radiation
Death from prostate cancer or treatment within 8 to 10 years 4 to 8 out of 100 men 6 out of 100 men 3 out of 100 men

*Based on the best available evidence (evidence quality: borderline to moderate).

Risk of erection and bladder problems*
Problems men had 2 to 3 years after starting surveillance or other treatment Active surveillance Surgery Radiation
Erection problems 44 to 47 out of 100 men 81 out of 100 men 59 out of 100 men
Bladder problems 2 to 6 out of 100 men 17 out of 100 men 17 out of 100 men

*Based on the best available evidence (evidence quality: borderline to moderate).

Men who left active surveillance*
Men who left active surveillance within 10 years to have other treatment, such as surgery or radiation, because of signs of cancer growth or spread or for other reasons. 33 out of 100 men

*Based on the best available evidence (evidence quality: borderline).

Benefits

The quality of the evidence about the benefits of active surveillance is borderline to moderate.

Survival

For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance offers them about as good a chance of survival as surgery or radiation.

Take a group of 100 men 8 to 10 years after diagnosis .

  • 4 to 8 out of 100 men on active surveillance died from their cancer or its treatment. This means that 92 to 96 out of 100 did not.
  • 6 out of 100 men who had surgery died from their cancer or its treatment. This means that 94 out of 100 did not.
  • 3 out of 100 men who had radiation died from their cancer or its treatment. This means that 97 out of 100 did not.

These numbers are close enough that experts believe they don't clearly prove that surgery or radiation is a better treatment choice than active surveillance.

Fewer erection problems

Men on active surveillance have fewer erection problems than men who have surgery or radiation.

Take a group of 100 men 2 to 3 years after starting treatment .

  • 44 to 47 out of 100 men on active surveillance had erection problems. This means that 53 to 56 out of 100 did not.
  • 81 out of 100 men who had surgery had erection problems. This means that 19 out of 100 did not.
  • 59 out of 100 men who had radiation had erection problems. This means that 41 out of 100 did not.
Fewer bladder problems

Men on active surveillance have fewer bladder problems than men who have surgery or radiation.

Take a group of 100 men 2 to 3 years after starting treatment .

  • 2 to 6 out of 100 men on active surveillance had bladder problems. This means that 94 to 98 out of 100 did not.
  • 17 out of 100 men who had surgery had bladder problems. This means that 83 out of 100 did not.
  • 17 out of 100 men who had radiation had bladder problems. This means that 83 out of 100 did not.

Risks

The quality of the evidence about the risks of active surveillance is borderline.

There is a chance that your prostate cancer will grow or spread during active surveillance. If this happens, your doctor may recommend other treatment, such as surgery or radiation.

Take a group of 100 men who chose active surveillance .

  • Within 10 years after starting active surveillance, about 33 out of 100 men had other treatment, such as surgery or radiation. This means that about 67 out of 100 did not. Most of these men left because there were signs that their cancer grew or spread. Some left for other reasons.

Keep in mind that the risk that your cancer might get worse may not be the same as someone else's risk. To find out the risk that your cancer might get worse, your doctor will look at your biopsy results, your Gleason score, your PSA levels, the stage of your cancer, and other factors.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.2, 1, 3, 4 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Why might your doctor recommend active surveillance?

Your doctor might recommend active surveillance if:

  • Your cancer is slow-growing and hasn't spread outside the prostate.
  • Your age and current health make you a good candidate for active surveillance.
  • You want to delay or avoid surgery or radiation and its side effects.

2. Compare your options

  Use active surveillance Have surgery or radiation instead of active surveillance
What is usually involved?
  • You will have regular checkups and tests (including prostate biopsies) to watch for any changes in your cancer.
  • If your cancer grows, you will need to have surgery or radiation.
  • You will have surgery or radiation to get rid of the cancer.
  • After surgery or radiation, you will have regular checkups to make sure the cancer hasn't come back.
What are the benefits?
  • You can delay or avoid surgery or radiation and its side effects.
  • Active surveillance offers about as good a chance of survival as surgery or radiation.1, 2
  • You can keep your current quality of life and continue your normal activities.
  • You can decide later if you want to have surgery or radiation.
  • You treat the cancer right away.
  • Surgery or radiation offers about as good a chance of survival as active surveillance.1, 2
What are the risks and side effects?
  • The cancer may grow or spread during active surveillance.
  • Risks of prostate biopsies include bleeding and infection.
  • You may worry that the cancer might get worse between checkups.
  • The cancer could come back.
  • Surgery and radiation have serious side effects, such as erection, bladder, and bowel problems.
  • Risks of major surgery include bleeding, infection, blood clots, problems from anesthesia, and possibly death.
  • Risks of radiation include skin changes (dry, itchy, red skin with peeling or blistering), diarrhea or rectal pain, fatigue, and pain or burning when urinating.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about considering active surveillance

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When I found out I had prostate cancer, I was scared. My first thought was, "Get it out, now!" But my doctor said that with frequent checkups, I could wait to have surgery, and that I may never even need surgery. After a lot of thought, I decided to wait. I decided that the best way for me to deal with the stress of waiting was to focus on taking better care of myself. So now I'm at the gym 4 times a week, eating a healthier diet, and making sure I get good sleep. I'm also doing more of the things I enjoy, like going fishing with my grandson. And so far, so good. It's been 3 years since I was diagnosed, and I'm doing great."

— Alex, 72

"I'm not a patient man. If something needs to be done or taken care of, I don't wait. So when my doctor told me I had prostate cancer, there was no question in my mind that I wanted to treat it right away. For me, waiting to see what might happen wasn't an option—even though my doctor said that it was. I was told about all the possible side effects of surgery, which weren't pleasant and certainly not something I was looking forward to. But I decided that dealing with the side effects would be easier than dealing with the anxiety of knowing that my cancer could grow or spread at any time if I waited. I just knew that I couldn't live with that uncertainty."

— Ralph, 64

"If anyone would have told me that I would get prostate cancer someday, let alone have to decide what to do about it, I would have said that it could never happen to me. But it did. My doctor told me that my chances for survival were about the same no matter which treatment I chose. And he suggested I try active surveillance. At first I wasn't sure about waiting. But my brother-in-law told me about the problems he's had since his prostate surgery. After talking about it with my family, I decided to wait. I know that I still might need to have surgery or radiation someday, but the longer I can put off the side effects of these other treatments, the better."

— Darnell, 75

"Once I got over the shock of being diagnosed with prostate cancer, I had to decide what to do next. I was really anxious about making the right decision, because the only person I knew who had prostate cancer died from it. And I didn't want that to happen to me. I grappled with the idea of waiting to have surgery. This seemed like a reasonable option since my cancer was small and hadn't spread. But knowing there was a chance that it could get bigger or spread during this time made me nervous. I knew if that were to happen, I would regret not having done something more aggressive from the start. So I decided to have surgery. I know that even with surgery there isn't any guarantee that my cancer won't come back. But at least for now, I'm cancer-free."

— Rodney, 67

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to use active surveillance

Reasons not to use active surveillance

I want to avoid surgery or radiation for as long as I can.

I want to get rid of my cancer right away.

             
More important
Equally important
More important

I'm willing to take the risk that the cancer will grow or spread.

I'm worried that if I wait to have surgery or radiation, my cancer will grow or spread.

             
More important
Equally important
More important

I'm worried that I might not be able to deal with the side effects of surgery or radiation.

I'm willing to deal with the side effects of surgery or radiation.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Using active surveillance

Having surgery or radiation instead of using active surveillance

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Will all men with prostate cancer need surgery or radiation?

  • Yes
  • No
  • I'm not sure
No, that's not right. A study shows that about 67 out of 100 men still did not need other treatment, such as surgery or radiation, within 10 years after starting active surveillance.

2. During active surveillance, do you need to have regular checkups and tests?

  • Yes
  • No
  • I'm not sure
You're right. During active surveillance, your doctor will watch for any changes in the cancer. You will have frequent checkups and tests, such as PSA (prostate-specific antigen) tests, digital rectal exams, and prostate biopsies.

3. Does active surveillance offer you about the same chance of survival as surgery or radiation?

  • Yes
  • No
  • I'm not sure.
That's right. For most men who have prostate cancer that is low-risk and not likely to spread, active surveillance, surgery, and radiation offer about the same chance of survival.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology

References
Citations
  1. Lu-Yao GL, et al. (2010). Outcomes of localized prostate cancer following conservative management. JAMA, 302(11): 1202–1209.
  2. Wilt TJ, et al. (2012). Radical prostatectomy versus observation for localized prostate cancer. New England Journal of Medicine, 367(3): 203–213.
  3. Chou R, et al. (2011). Screening for prostate cancer: A review of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 155(11): 762–771.
  4. Klotz L, et al. (2010). Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. Journal of Clinical Oncology, 28(1): 126–131.

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