Active surveillance or watchful waiting is the name given when prostate cancer has been diagnosed and a decision has been made to not treat the cancer. It is used in two types of circumstances. The first is when a man around his 70’s with significant other medical problems is diagnosed with prostate cancer and a decision is made not to treat him with curative intent. For men to benefit from prostate cancer treatment with curative intent they need to have a life expectancy of greater than 7 years. A man in this situation if likely to die of other causes before the prostate cancer causes him problems. So in this situation, he is monitored with regular PSA tests and is treated usually with hormone therapy should his prostate cancer progress.

The second situation where active surveillance or watchful waiting is used is when a younger man is diagnosed with prostate cancer and he is definitely suitable for treatment with curative intent. Men with a low Gleason Score of 6 and a low PSA have approximately a 20% chance of their prostate cancer progressing. In this situation not all men will die from their prostate cancer but some will die with it and die from other causes. These men are suitable for an active surveillance program. The premise of an active surveillance program is that there is a low risk of the prostate cancer progressing so a conservative approach of close monitoring of the prostate cancer is undertaken and if there is evidence that the prostate cancer is progressing then active treatment is undertaken at that point. An active surveillance program consists of the following:

• A repeat saturation prostate biopsy to ensure that the prostate cancer was not under graded (which can occur in 30% of cases)

• 6 monthly PSA tests

• 6 monthly digital rectal examinations

• 18 -24 monthly prostate biopsies

Patients are then treated with curative intent if they have evidence of a change in their digital rectal examination findings, a rising PSA or more aggressive cancer found on the follow up prostate biopsies.

It has been found that in long-term follow-up of patients undergoing no active treatment the outcomes have been comparable to the outcomes of active treatments, though this must be in a low grade or slow growing cancers.