Active Surveillance

What is active surveillance?

Active surveillance is one way that healthcare providers manage health conditions, like cancer, in their early stages. You undergo regular monitoring and tests to see if your condition changes. The goal of active surveillance is to delay treatment until it’s necessary.

If you have cancer that tends to grow slowly — like prostate cancer — your provider may recommend active surveillance. This approach to disease management helps your healthcare team know if (or when) you need treatment. Researchers report that nearly 60% of people diagnosed with low-risk prostate cancer are on active surveillance.

Who qualifies for active surveillance?

Active surveillance may be right for you if:

• Cancer doesn’t cause symptoms or affect your quality of life.
• Tumors are small or slow-growing.
• You have other chronic health conditions.

If you have prostate cancer, talk to your healthcare provider to see if you meet active surveillance criteria such as:

• Cancer that hasn’t spread beyond your prostate.
• Prostate cancer that isn’t considered aggressive according to tumor size, growth or your Gleason score.

What conditions can be managed with active surveillance?

Some cancers grow slower than others. Depending on your health and cancer type, active surveillance may be right for you.

Your provider may use active surveillance if you have:

• Breast cancer, including ductal carcinoma in situ (DCIS).
• Kidney cancer, including renal cell carcinoma.
• Thyroid cancer.

What happens during active surveillance?

During active surveillance, you have regular visits with your healthcare provider and any tests they recommend. Your provider uses this information to keep track of tumor size and see if the cancer is growing. You have more frequent physical examinations and tests such as:

• Blood tests for cancer.
• CT scan.
• MRI.
• PET scan.
• Biopsy.

What is the prostate cancer active surveillance protocol?

If you have active surveillance for prostate cancer, your provider will follow certain protocols (guidelines). Typically, once or twice each year, you’ll have a:

• Digital rectal exam.
• PSA test.

Every one to five years, you may have a prostate ultrasound and biopsy. Your provider may also recommend an MRI-guided prostate biopsy.

How long can you be on active surveillance?

You can be on active surveillance for your whole life. Your healthcare provider checks you regularly to make sure the cancer isn’t growing or progressing. If symptoms develop or the tumor grows, your provider discusses when to stop active surveillance and switch to more active treatment.

What are the pros and cons of active surveillance?

Advantages of active surveillance include avoiding cancer treatments like surgery and radiation therapy until you need them. But this approach isn’t right for everyone. You may be anxious about having cancer and feel like you should have treatment. You may worry that you won’t know if cancer is growing. Talk to your provider about your concerns.

How successful is active surveillance?

Active surveillance doesn’t treat cancer. But the approach can protect your quality of life by preventing side effects of treatment.

What are the risks or complications of active surveillance?

Active surveillance can sometimes mean a delay in learning that cancer is growing and getting treatment. When cancer grows, it can spread to other parts of your body (metastasize).

What is the life expectancy for active surveillance for prostate cancer?

If cancer doesn’t grow and symptoms don’t develop, you’ll likely have a typical life expectancy.

Some people with prostate cancer stay on active surveillance for years after diagnosis.

When should I call my healthcare provider?

Talk to your healthcare provider if you develop new or worsening symptoms.

What’s the difference: Active surveillance vs. watchful waiting?

During both active surveillance and watchful waiting, your provider monitors you carefully. But there are some differences between them.

In active surveillance, you’ll have regular tests to check on your cancer, with the goal of starting treatment when the time is right.

With watchful waiting, the goal is more about symptom management than treatment. You’ll check in with your provider and report any new symptoms, but there won’t be a lot of tests to monitor the cancer.