active surveillance for men with prostate cancer is the postponement of immediate treatment or therapy with the following modalities: brachytherapy, external beam radiation, hormonal therapy (androgen deprivation therapy), and or surgery. active surveillance is an accepted option for the initial management of carefully selected men with localized prostate cancer thought to be at low-risk for progression. 

Men who are under active surveillance for prostate cancer will likely undergo periodic evaluations including prostate specific antigen (PSA) tests, digital rectal examinations, and or prostate biopsies. This allows for the physician to monitor the prostate cancer for any progression. 

active surveillance is typically only offered as an option to patients who show very low risk for cancer growth, however it is important to consider the risk of prostate cancer progression associated with this option. 

Men who choose active surveillance need to have the correct mindset for this option, as knowledge of having cancer and not treating it can cause anxiety. It is important to work with your physician to discuss the context of your unique health situation.

Who are the best candidates for active surveillance?:

• Men who have the ability to live with cancer without worry reducing their quality of life 
• Men who are willing to commit to the serial exams, PSA’s and biopsies 
• Men who are most concerned about the potential side effects of treatments  

active surveillance guidelines:

• Gleason score 3+3=6 or 3+4=7 (if very low percentage of core) 
• PSA less than 10 
• No more than 2 positive cores or cancer involving no more than 50% of any core 
• tumor is small and expected to grow slowly  
• Cancer is confined to the prostate  

Serial Monitoring:

• PSA every 3-6 months 
• Digital Rectal Exam at least once a year 
• Prostate biopsy every 1-2 years

Resources:

active surveillance Patients International: https://aspatients.org/ 

The Active Surveillor: https://howardwolinsky.substack.com/