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Introduction to active surveillance

This not a treatment as such as the prostate is not ‘treated’. Instead, it’s more of an approach to managing the disease. This may sound strange, so let us explain.

The word ‘cancer’ frightens a lot of people, and many automatically assume that it implies aggressive cancer with aggressive treatment options required. However, this is not the case for all cancers. Because many prostate cancers are slow growing and have not spread, it’s common in fact for men to outlive their prostate cancer – they may never need treatment. This is particularly the case for low grade tumours in older men and it can work well for some patients. It’s more of a wait-and-see approach and if your cancer does progress, then you can usually have it treated successfully because it is being monitored.

Watch Professor Eden explain active surveillance as an option

What it involves

Just as when you were first tested for prostate cancer, you will undergo the same tests, except with more frequency:

  • PSA tests every 3-6 months with your GP and follow-ups with your urologist;
  • MRI scan each year;
  • repeat prostate biopsy every 2 years.

If your tests show evidence of tumour progression (rising PSA, increasing abnormality on the MRI scan or biopsies that show either an increasing amount or aggressiveness of cancer) you will be advised to stop active surveillance and have some form of definitive treatment, such as radiotherapy or surgery. This applies to approximately a third of active surveillance patients. A further third abandon active surveillance because of anxiety and the intensive surveillance protocol.


  • There’s no recovery time or side effects as direct treatment is not involved;
  • For self-paying private patients it is a lower cost option than radiotherapy or surgery.


  • It may be stressful to know that you are living with cancer.
  • You may feel anxiety when undergoing your tests, as at any time they may show that your cancer has developed further.
  • There is a small chance that your cancer can develop too quickly to be able to treat it successfully.
  • You are required to undergo further tests including prostate biopsy, which not all patients would find acceptable.

Next chapter: radiotherapy