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Active Surveillance

Active surveillance is an option for low-risk early stage prostate cancer. This strategy monitors the disease for progression, delaying active treatment.

A doctor and a male patient in a gown talking

What is active surveillance?

Active surveillance is a disease management strategy for low-risk early-stage prostate cancer. This strategy monitors the disease for progression but avoids immediate treatment with surgery or radiation, and their corresponding side effects.

Who should consider active surveillance?

Men with low-risk, early-stage prostate cancer can discuss active surveillance with their doctor. As many as 50% of men with prostate cancer have low-risk disease that will not require immediate or aggressive treatment because it is unlikely to spread.

If you are weighing active surveillance against surgery, one study indicated that men with low-risk prostate cancer can safely delay undergoing a radical prostatectomy for up to 12 months after their cancer diagnosis.

Active surveillance can be valuable for some men because it allows them to avoid the side effects of treatment.

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If there is no difference in mortality between active surveillance and immediate treatment, then quality of life is the defining issue.

— Mark Litwin, MD, MPH
Mark Litwin, MD, MPH

How does active surveillance work?

With active surveillance, your doctor will monitor your prostate cancer through regular tests to see if it is becoming more aggressive or spreading. This will include repeat PSA tests, digital rectal exams, and biopsies. It may also include additional imaging tests. Through this close, careful monitoring, your healthcare team will know if the cancer becomes more aggressive and you can discuss the right treatment option for you.

If your doctor discusses active surveillance with you, make sure you have a clear plan for follow-up tests and next steps.

Informational graphic about Watchful Waiting

Active surveillance vs. watchful waiting

You may see the terms “active surveillance” and “watchful waiting” used interchangeably. Although they are very similar strategies, they are used in somewhat different situations.

Watchful waiting is used more often for men who may be older or less healthy, with a shorter life expectancy. In these cases treatment for prostate cancer may be difficult to perform or do more harm than good. Regular and repeat tests are performed for disease progression, but may be less frequent than in active surveillance and avoid repeat biopsies.


Watch the videos below to learn more about active surveillance and watchful waiting.