Active Surveillance of Prostate Cancer

One of the limitations of prostate-specific antigen, or PSA, screening and random prostate biopsy without image guidance is that doctors may detect some small or slow-growing prostate cancers that are not likely to cause serious consequences.

NYU Langone doctors have the experience and technology to identify these lower-risk tumors. Doctors may recommend active surveillance of a low-risk tumor instead of treating it with interventions including surgery or radiation therapy, particularly in older men. 

Active surveillance means deferring, and hopefully avoiding, treatment of a slow-growing prostate cancer to avoid the potential side effects of treatment, such as urinary incontinence, rectal injury, bladder dysfunction, and loss of erectile function. It requires that doctors carefully follow any progression of prostate cancer in men who have tested positive for the disease by biopsy which may require a reassessment of whether therapies such as surgery should be considered.

Because there are currently no widely accepted standards for following men enrolled in an active surveillance program, NYU Langone doctors have received funds from the National Institutes of Health to develop evidence-based methods for active surveillance. 

For men who choose active surveillance for prostate cancer, doctors at NYU Langone typically conduct follow-up PSA tests every six months and follow-up biopsies at individualized intervals. Doctors move on to treatment such as surgery, radiation therapy, or focal ablation only if there is evidence that the cancer is progressing. 

It is not possible to guarantee that any cancer is truly low-risk, or not likely to spread. All men under active surveillance at NYU Langone’s Smilow Comprehensive Prostate Cancer Center are advised to get an MRI-guided biopsy of the prostate before pursuing this course of action under the supervision of their doctor.

Your doctor may consider beginning treatment if there is a significant increase in your PSA level, a change in your digital rectal examination or MRI results, or if a prostate biopsy shows that the cancer has become more aggressive, or grows quickly.

More Prostate Cancer Resources