Active Surveillance (AS) is the monitoring of low-risk prostate cancer.

We know very low-risk prostate cancer doesn’t spread or cause death. We monitor it rather than treat it for this reason. We monitor patients rather than discharge them in case we have under sampled the cancer at the original assessment.

We believe monitoring with a four-to-six-monthly blood test, annual clinic review and an MRI scan two yearly are enough to monitor cancer and pick up if things change in a timely manner.

MRI scans and targeted prostate biopsies are how we ultimately prove if things are changing and if treatment is needed or not.

Patients can be assured Active Surveillance works if we:

  1. Convince you that low-risk prostate cancer (especially Gleason 3+3) is safe.
  2. Demonstrate why we are confident that we have assessed you thoroughly enough and we are not missing life-threatening disease.
  3. Describe the published data describing the risks long-term: 1-3% mortality at 15 years. However, these patients didn’t have MRI or transperineal targeted biopsies. They were at high risk of under-sampling. We believe your risk is better than the data described above from these patients.
  4. Explain how we are going to monitor you and plan the blood tests, annual review and MRI follow up. The MRI will be 1-2 yearly depending on risk and time elapsed since diagnosis.
  5. Realistically we probably over-survey our patients which initially is very reassuring for them.
  6. We will discuss the triggers for switching to treatment.
  7. We will discuss what that treatment would be.
  8. While managing your surveillance, we will also manage any urinary symptoms and bother that may have caused you to seek medical advice in the first place.
  9. We will inform you so that you are in control with full understanding.
  10. We will put you at the centre of everything we do.

We are looking at the triggers for treatment in Active Surveillance in the SPCG-17/PCAST trial (you can download the Open Access paper here). We can discuss this trial with you.

Please see some of our Active Surveillance research here.

This is a link to a lecture on Active Surveillance which has a great deal of information and we can use in the clinic to help inform you.