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Updated on October 13, 2022
Sometimes, prostate cancer doesn’t need any treatment—at least not right away. Because the tumor tends to grow slowly, if you are diagnosed with low-risk prostate cancer, you may decide to defer immediate treatment with surgery or radiation and instead keep tabs on it over time using an approach called “active surveillance.”
Active surveillance may involve routine PSA (prostate specific antigen) blood tests, prostate exams, MRIs, and biopsies to check for any signs that a tumor may be growing. These tests can be conducted by several types of healthcare providers (HCP), including urologists and oncologists.
The approach is growing in popularity. In a study that included data from more than 84,000 patients across 240 urology practices around the United States, nearly 60 percent of men diagnosed with low-risk prostate cancer were being managed with active surveillance as of the end of 2021. Rates of active surveillance more than doubled between 2014 and 2021, according to the findings presented at the American Urological Association’s 2022 annual meeting.
There is one potential flaw with active surveillance, however: A large number of patients who are prescribed active surveillance may not follow up on their monitoring plan.
Low adherence to active surveillance may be an issue
In a study presented at the American Society of Clinical Oncology Annual Meeting in 2019, 346 men with recent diagnoses of low- or intermediate-risk prostate cancer were followed between 2011 and 2013. Researchers from the University of North Carolina Lineberger Comprehensive Cancer Center found that only 15 percent of the patients who chose active surveillance instead of treatment actually followed the recommended plan.
The consequences of not sticking to a monitoring plan can be costly. When patients avoid the screening tests and HCP appointments that are part of active surveillance, they may not know if their cancer is growing—and potentially turning into a life-threatening problem.
There are a variety of reasons why patients may begin—but then not pursue—active surveillance. They may believe their cases aren’t life-threating or feel that receiving ongoing testing isn’t necessary. They may also prefer not to know how severe their cancer may be or they may prefer not to contemplate the need to make difficult treatment decisions.
The bottom line is that maintaining the regular schedule set by your HCP is necessary to ensure the best outcomes.
Scheduling regular checkups is key
According to the American Cancer Society (ACS), active surveillance of prostate cancer typically involves checkups and PSA testing every six months. Your HCP may also do a digital rectal exam (DRE) annual visits to see if the cancer has grown. Patients may need a biopsy or imaging tests every one to three years, as well.
The ACS notes that men who have prostate cancer surgery or radiation therapy do not seem to live longer than those who receive active surveillance (although cancer may be less likely to spread with treatment).
It’s worth noting that active surveillance does not mean HCPs remain passive when it comes to cancer: Treatment can be started immediately if one of the tests suggests that a patient’s cancer is getting worse.
Regular checkups following a prostate cancer diagnosis is standard care. But equally important is a patient’s will to follow through with those regular HCP visits. Even if it’s initially deemed low-risk, prostate cancer can be deadly if it spreads beyond the prostate. So if your HCP recommends active surveillance, it’s important to take your treatment plan seriously and to follow up on all recommended appointments.
