With active surveillance, a man opts to have no immediate treatment but undergoes close monitoring for cancer progression. This treatment approach is most often recommended for men with very-low- to low-risk prostate cancers that are believed to be small volume, especially older men whose cancers are unlikely to become life threatening during the remaining years of their life.
Men who choose active surveillance must see their doctor regularly and undergo testing to determine whether the cancer has progressed. If it has, curative treatment options such as radical prostatectomy or radiation therapy may be considered at that point.
Recommendations on the frequency of visits and the tests conducted each time vary from doctor to doctor. Between visits, men who choose active surveillance should call their doctor if they experience any of the following symptoms: blood in the urine, difficulty urinating, or new onset of pain.
An option for some men who choose to forgo immediate treatment is watchful waiting. Men with high-grade tumors, which have a relatively poor prognosis with any treatment, may consider watchful waiting. As with active surveillance, a man who chooses watchful waiting opts to have no immediate treatment and, instead, undergoes periodic monitoring for cancer progression.
However, if and when the cancer progresses, palliative treatment (therapy aimed at relieving pain and limiting disease complications rather than at curing the disease) is provided.
For a man whose cancer has not spread outside the prostate, options for palliative treatment include procedures to manage urinary tract obstruction, such as transurethral resection of the prostate (TURP). If the cancer has spread to other organs, options for palliative therapy include hormonal therapy and radiotherapy.
Recommendations on the frequency of visits and the tests conducted at each appointment vary from doctor to doctor. However, follow-up for men on a program of watchful waiting is less aggressive than for those who choose active surveillance. As with active surveillance, men who are undergoing watchful waiting should call their doctor if they experience blood in the urine, difficulty urinating, or new onset of pain.