Because prostate cancer often grows very slowly, some men (especially older men or those with other serious health problems) might never need treatment for the prostate cancer. Instead, their doctors may recommend approaches known as expectant management, watchful waiting, observation, or active surveillance.
Active surveillance means holding off treatment and monitoring the cancer closely with PSA blood tests, digital rectal exams, and ultrasounds at regular intervals to see if the cancer is growing. Prostate biopsies may be done as well to see if the cancer is becoming more aggressive. If there’s a change in your test results, your doctor would then talk to you about treatment options.
Watchful waiting (observation) is sometimes used to describe a less intensive type of follow-up that may mean fewer tests and relying more on changes in a man’s symptoms to decide if treatment is needed.
If you choose the active surveillance option you are choosing to delay the side-effects and risks associated with surgery or other therapies. However, you run the risk of reducing your chances of controlling the cancer before it spreads.
It can be stressful for some men to know they’re living with an untreated cancer and it’s very important to discuss your feelings with your doctor. You can change your mind and opt for treatment at any time.
Questions to ask your Doctor
- Is putting off treatment a safe option?
- Will I live longer if I choose treatment rather than active surveillance?
- What happens if I change my mind?
- How often will I need to have tests? What tests will I need to have?
- How will we know when the cancer gets worse or starts spreading?
- Are there certain symptoms I need to look out for between doctor visits?
A raised PSA level doesn’t necessarily mean you have prostate cancer.
Only about 1 in 4 men who have a raised PSA level turn out to have prostate cancer. Your doctor will need to interpret your PSA result based on your recent activity, age and previous medical history. They can then decide on whether to carry out further tests.