A beginner’s guide to Active Surveillance
Active Surveillance is a structured way to manage certain prostate cancers with regular monitoring instead of immediate surgery, radiation, or another treatment.
If Active Surveillance is a realistic option, you have time to understand your diagnosis, ask questions, and consider your options. You should not be rushed into immediate treatment.
Created by patients, survivors, and advocates, ASPI helps men and their families understand Active Surveillance, take an informed role in their care, and connect with others who have faced similar decisions. This guide explains the basics in plain language.
The cancer is monitored carefully instead of treated immediately.
Active Surveillance uses planned PSA tests, appointments, and imaging to watch the cancer over time. Additional tests are added when they are needed to clarify a result. This is different from watchful waiting, which generally uses less intensive testing and focuses more on symptoms.
Many men remain on Active Surveillance for years, and some stay on it indefinitely without needing treatment. Surgery, radiation, or another treatment remains an option only if later findings show that a different approach is needed.
Eligibility depends on the cancer’s risk and your overall situation.
Your doctor considers your Grade Group, PSA and PSA density, biopsy, examination, and MRI together. Micro-ultrasound or biomarker tests may add useful information in some situations.
Active Surveillance requires regular testing and appointments. Your overall health, priorities, comfort with monitoring, and ability to keep up with the schedule are part of the decision.
Your care team sets a schedule based on your results and adjusts it when needed.
PSA can change for reasons other than cancer growth. Decisions are based on patterns over time and the combined results of imaging, biopsy, examination, and other tests.
One changed result is reviewed in context before the plan changes.
A PSA rise, imaging change, or other new result does not decide the next step by itself. Your care team may repeat a blood test, review imaging, seek another opinion, or consider a biopsy if an important question remains.
After review, the plan may stay the same, monitoring may become closer, or other options—including treatment—may be discussed. Many men continue on Active Surveillance. A change in the plan is not inevitable and is not a failure.
Take these three questions to your next appointment.
When you are ready to learn more, these ASPI resources can help you understand terms, prepare questions, and learn from patients and experts.
ASPI’s step-by-step guide to test results, monitoring, decisions, and questions to ask your doctor.
Read The Pathway
Use the glossary to understand common terms in appointments, reports, and test results.
Open the Glossary
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