Treatment Overview

Active surveillance (watchful waiting) is a good treatment choice for men who have prostate cancer that is low-risk and not likely to spread (early stage). Whether this is a good choice for you is something you will want to discuss with your doctor. Together you and your doctor will want to consider:

• Your life expectancy.
• The stage and Gleason score of your cancer.
• Your general health.
• The possible side effects you might have from other treatments.

Your personal preference needs to be part of this decision.

With active surveillance, you and your doctor will watch your cancer closely to see if it causes any symptoms or appears to be growing. During this time, you will have checkups and tests, such as PSA tests and digital rectal exams. You may also have prostate biopsies.

It may seem odd to have cancer and not have surgery to remove it or radiation therapy to kill the cancer. But unlike many other cancers, most prostate cancer grows very slowly. Slow-growing prostate cancer does not normally cause symptoms, so it is possible to have prostate cancer for years without ever knowing it.

Prostate cancer treatments like surgery, radiation, and hormone therapy have serious side effects. These side effects include bladder, bowel, and erection problems. With active surveillance, men who have low-risk prostate cancer can wait to start other treatment. Some men will never need more treatment. And others can delay dealing with any side effects until tests show their cancer is growing more quickly.

If you choose active surveillance, you are taking a chance that your cancer will spread and become incurable during that time. But this is not common. Regular checkups will increase your chances to find out right away if your prostate cancer grows. That way your cancer still can be treated in the early stages, when treatments are more successful.

Active surveillance may mean not having treatment to cure the cancer even if it grows. Some men choose not to have any treatment because they have another medical condition, such as a heart condition or diabetes. Or they may only have a short time to live. Either way, they may not be strong enough for treatments such as surgery or radiation. These men may choose to only have treatments to stay comfortable.

Unless you only have a short time to live, if your prostate cancer is faster-growing (higher-grade), your doctor probably will recommend other treatments. Each type of prostate cancer treatment has its pros and cons. And it is important that you and your doctor think about both when making your treatment decisions.