Active surveillance for prostate cancer

Last medical review:

Many men diagnosed with prostate cancer don't need to be treated right away. This is because most prostate cancers grow slowly and are unlikely to spread outside of the prostate. Those with localized prostate cancer that has a very low risk of growing quickly or spreading may be offered active surveillance. This means that your healthcare team watches the cancer closely rather than giving treatment right away. During active surveillance, the cancer is closely monitored for signs with tests and exams to check if prostate cancer is growing or spreading or your condition is getting worse. Treatment is given when you develop symptoms or the cancer changes.

Using active surveillance helps avoid side effects that can happen with treatments such as surgery or radiation therapy. There is no evidence so far that people won't live as long when they get active surveillance compared to other treatments. And there is no evidence that active surveillance has other negative effects if or when you start treatment.

Who is treated with active surveillance

You may be offered active surveillance if:

  • the cancer is small
  • the cancer is only in the prostate
  • the cancer isn't causing any symptoms
  • the cancer is expected to grow slowly (it is Grade Group 1 or 2)
  • the cancer is very low or low risk
  • the prostate-specific antigen (PSA) level is less than 10 ng/mL
  • you prefer not to have treatment right away so you can avoid treatment-related side effects and keep the quality of life that you're used to

During active surveillance

You will have tests every 3 to 6 months to monitor the cancer. Tests may include:

  • the PSA test
  • a physical exam, including a digital rectal exam (DRE)
  • a prostate biopsy
  • a bone scan, chest x‑ray or CT scan depending on the signs and symptoms that develop
  • an MRI of the prostate in some cases

When treatments are started

Treatments, such as surgery or radiation therapy, are started if:

  • the PSA level keeps going up over time
  • samples from follow-up biopsies are given a higher Gleason score
  • symptoms develop and tests show the cancer is starting to grow

Some men find it reassuring to have treatments for prostate cancer even if they are unlikely to help them live longer. These men may be offered treatments soon after they are diagnosed.

Talk to your doctor about the advantages and disadvantages of active surveillance, treatment options and potential side effects. This will help you to choose the treatment option that is best for you.

Expert review and references

  • Peter Chung, MBChB, FRCPC
  • Krista Noonan, MD, FRCPC
  • American Cancer Society. Treating Prostate Cancer. 2019:
  • American Society of Clinical Oncology. Prostate Cancer. 2020:
  • Tracy, CR. Prostate Cancer. eMedicine/Medscape; 2020:
  • Garnick MB (ed.). Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
  • Mir MC, Stephenson AJ . Expectant management of localized prostate cancer. Nargund VH, Raghavan D, Sandler HM (eds.). Urological Oncology. Springer; 2015: 41: 719-730.
  • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment (PDQ®)–Patient Version. Bethesda, MD: National Cancer Institute; 2020:
  • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment (PDQ®)–Health Professional Version. Bethesda, MD: National Cancer Institute; 2020:
  • National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer (Version 3.2020) . 2020 .
  • Princess Margaret Cancer Centre. Princess Margaret Cancer Centre Clinical Practice Guidelines: Prostate Cancer. 2015:
  • Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 70: 1087-1136.
  • Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up . Annals of Oncology . 2020 : 31(9): 1119-1134 .

Medical disclaimer

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