Active surveillance

taken from Small Gland, Big Problem 4th Edition
by Professor Roger Kirby, Health Press 2011

When you first hear of active surveillance, which entails regular monitoring but no immediate treatment, you may think ‘what a cop-out’, and media reports of older patients receiving second-rate healthcare may spring to mind. But active surveillance is not a second-rate option at all – it is often a way of allowing you to retain maximum quality of life.

The chance that a small slow-growing tumour will cause problems to an older man before the end of his natural life is often relatively slight. On balance, the side effects of the other treatment options would probably cause far greater distress. As the name ‘active surveillance’ suggests, although you will not receive treatment, you will have regular check-ups and your urologist will monitor your condition closely with PSA measurements, scans and usually repeat prostate biopsies.

If you choose the active surveillance option you must, for your own peace of mind, be convinced that it is right for you. Despite all the progress made in early diagnosis and treatments, a diagnosis of cancer of any kind is still distressing for the patient, and for his family and friends. It would be a rare person who, having been told that he has cancer, then manages to put the diagnosis out of his mind. It is all too easy to understand everything and feel confident that you are doing the right thing while you are in the urologist’s consulting room, and then a few weeks later start to feel panicked and uneasy that nothing is being done about your condition. Remember that the whole point of active surveillance is that your quality of life remains good – if you start to worry unduly, perhaps losing sleep, then your quality of life is suffering. If this happens, pick up the phone or write to your GP or urologist and tell him how you feel. You might also find that becoming involved with a support group helps (see page 105). As well as having careful follow-up, it is important to change your lifestyle by increasing the amount of exercise you do and improving your diet (see pages 6–8).

Typical monitoring timetable in active surveillance
First year
  • PSA test followed by a digital rectal examination every 3 months
  • Repeat MRI scan followed by prostate biopsy at 1 year
  • Case review by multidisciplinary team after 1 year’s results are known*
After 1 year, if no sign that the cancer has progressed
  • PSA test followed by a digital rectal examination every 6 months
  • Repeat MRI scan followed by prostate biopsy at 3-5 years
*If your cancer seems to be growing, your team will discuss active treatment options.