Active surveillance is a management strategy we use at Birmingham Urology Centre. It’s designed for men diagnosed with low-risk, localised prostate cancer that is not causing significant symptoms and is expected to grow very slowly. This approach involves closely monitoring your condition with regular tests and avoiding immediate invasive treatments unless the cancer shows signs of progression. This avoids the side effects of prostate cancer treatment for as long as possible while still being able to cure the cancer if required at any time in the future.
Monitoring prostate cancer
There are 2 ways to monitor prostate cancer
- Active surveillance
- Watchful waiting
- The aim of both is to avoid having unnecessary treatment but they are different. Other terms such as ‘active monitoring’ or ‘watch and wait’ may be used. It is important to check with your urologist which one you’re being offered as the reasons for having them are different. Active surveillance involves more regular reviews and investigations than watchful waiting
Who is Suitable for Active Surveillance?
Active surveillance is often recommended for men who have localised small volume cancer with low likelihood of spreading in the short to medium term:
Cambridge Prognostic Group 1 (CPG 1)
Also known as low-risk prostate cancer.
Characteristics include:
- Prostate specific antigen level (PSA) <10
- Grade grouping of 1 (or Gleason score 6)
- Cancer stage T1-2, indicating that the cancer is confined within the prostate.
Cambridge Prognostic Group 2 (CGP 2)
Sometimes suitable for those in the intermediate-risk category.
Characteristics include:
- PSA level between 10-20 ng/mL.
- Grade Group 2, equivalent to a Gleason score of 3+4.
- Cancer stage T1-2, indicating localised prostate cancer.
Active surveillance is sometimes suitable for men with more advanced Cambridge Prognostic Group 3 (CGP 3) localised prostate cancer who wish to avoid or delay treatment. Active surveillance is not recommended for more aggressive prostate cancer that has a high risk of spreading (CGP 4 or 5), where treatment will be advised. Link to treatments
If you have prostate cancer which is suitable for active surveillance, your urologist will discuss the advantages and disadvantages and ensure that you are informed about all the treatment options available to you. They will also assess whether you are fit enough to have treatment if your cancer starts to grow.
What to Expect During Active Surveillance:
You will have regular reviews with your urologist. This may involve one or more of the following:
- Review of your symptoms, if any.
- Digital rectal examination (DRE) to check the size and consistency of the prostate.
- Regular PSA blood tests usually every 3-6 months.
- Annual multiparametric MRI Scan (mpMRI).
- Prostate biopsies to closely monitor any changes in the cancer, the frequency of biopsy will depend on your PSA levels and mpMRI findings
- Other tests may be discussed: biomarkers
During active surveillance, you will attend regular appointments for tests to monitor the state of your prostate cancer. This vigilant approach ensures that any signs of progression are caught early, and treatment can be initiated at the most effective time.
What symptoms should I look out for?
Please contact your urologist without delay if you experience any of the following
- Frequent urination, especially at night.
- Difficulty or straining when urinating.
- Weak urine flow.
- Feeling like your bladder isn’t empty after urinating.
- Blood in your semen or urine.
- Bone pain (usually in the pelvic area or lower back).
- Feeling tired or unwell.
- Unexplained weight loss.
Benefits of active surveillance:
- Avoids or delays the side effects and risks associated with treatment such as urinary incontinence or erectile dysfunction.
- Has less impact on daily life and quality of life without the burdens of treatment side effects.
- Regular monitoring allows for timely intervention and curable treatment if your cancer shows signs of progression.
Disadvantages of active surveillance
- Uncertainty about living with cancer may cause anxiety.
- May need repeat prostate biopsies which can be painful and cause side effects.
- Your general health may deteriorate resulting in you not being able to have curable treatment.
- Rarely, your cancer can grow more quickly than expected resulting in missed opportunity for cure, your urologist will explain the risk of this situation when discussing active surveillance with you.
Will I need treatment in the future?
Active surveillance relies on the potential of having radical treatment, such as surgery or radiotherapy, in the future. This will depend on how your cancer behaves during the surveillance period. In addition, you can decide to have treatment for your cancer at any time, even if there are no signs of your cancer growing and no matter how long you have been on active surveillance. Some men find living with cancer and not having treatment stressful. Please contact us at Birmingham Urology Centre if you would like to discuss treatment options.
Transitioning to treatment
If test results during active surveillance indicate that your cancer is growing or becoming more aggressive, the team at Birmingham Urology Centre will discuss treatment options with you, usually surgery or radiotherapy. The transition from active surveillance to treatment is carefully managed to balance the benefits of early cancer control with the risks associated with treatment side effects.
Making an informed decision with the Birmingham Urology Clinic
Our specialists provide personalised care and are here to discuss all available treatment strategies to ensure you receive the best possible care tailored to your needs.
Choosing active surveillance involves careful consideration of your current health, cancer characteristics, and your personal preferences. It’s important to discuss this option thoroughly with your urologist to ensure it aligns with your lifestyle and long-term health goals. If you ever feel uncertain or if your circumstances change, our team at Birmingham Urology Centre is here to reassess your treatment options and support your health journey. We ensure you have all the necessary information to understand the potential risks and benefits, helping you make an informed choice about your prostate cancer treatment.
Contact us
If you have been diagnosed with prostate cancer and are considering active surveillance, or if you have any questions about your prostate cancer management options, contact Birmingham Urology Centre today. Our dedicated team is here to support you with expert advice and comprehensive care tailored to your individual needs.
