Not every person with prostate cancer needs to be treated right away. In many cases, early-stage prostate cancer will not spread or cause any problems or side effects for a long time, if ever. That's why your doctor may suggest active surveillance.

Active surveillance means choosing to actively keep track of your prostate cancer over time, instead of treating it right away. In this way, the side effects of prostate cancer treatment can be delayed without causing you harm. Treatment can then be done later if the prostate cancer changes and is growing larger or causing symptoms.

Active surveillance is not the same approach as watchful waiting (observation). You will have more exams, biopsies, and tests over time with active surveillance, but fewer with watchful waiting. Treatment to cure the cancer can readily begin if the cancer starts to grow or spread. Your doctor will talk with you about which approach is best for your cancer and what that means for you.

Your doctor will consider several things before offering active surveillance. These include your life expectancy, your overall health status, the specifics about your tumor and risk level, the side effects of treatment, and your preferences.

Active surveillance may be a choice for you if:

• Your doctor believes that your cancer is growing slowly.
• Your cancer is considered lower in risk.
• You have a small tumor that hasn't spread.
• You have a low Gleason score.
• You're younger and your life expectancy is 10 or more years.
• You're in good health.

Active surveillance may not be a choice for you if:

• You're older, with a life expectancy of less than 10 years, and you have serious health problems.
• Your cancer is growing quickly and is at a higher risk for spreading.
• Your cancer causes symptoms that affect your quality of life.
• You have anxiety about living with untreated cancer.

To see if active surveillance is a good choice for you, your doctor will need more tests to confirm your cancer, such as a special MRI, a prostate biopsy, or both. You'll likely see your doctor every 3 to 6 months. At each visit, your doctor will likely do a blood test. This is done to test the level of prostate-specific antigen (PSA) in your blood. You may also have a digital rectal exam, but no more than once a year, or as needed. You may also have a repeat prostate biopsy and a repeat special MRI from time to time. These tests can show signs that the cancer may be growing.

If your PSA level starts to go up, your doctor will carefully watch how fast it's rising. This rate of change is called the PSA velocity. Based on the results, your provider may advise a prostate biopsy to see if the cancer is growing faster. They may advise other tests as well. Your doctor can also help you decide if and when you want to start treatment. For example, you may choose to start treatment if your PSA reaches a certain level. Or you may start treatment if a biopsy shows the cancer is growing faster.

It's also important to let your doctor know about any new symptoms you have. New symptoms may be a sign that the cancer is growing. Ask your doctor what symptoms to watch for. And ask which symptoms mean you should call and be examined before your next scheduled appointment.

Talk with your doctor about factors that help you decide when to switch from active surveillance to starting treatment.