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.

Doctors at NYU Langone’s Perlmutter Cancer Center 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.

By offering personalized care that is supported by evidence-based medicine, our doctors can determine which men would benefit from active surveillance of slow-growing prostate cancers.

Active surveillance means deferring, and hopefully avoiding, treatment of a slow-growing prostate cancer. This helps men avoid the potential side effects of treatment, such as urinary incontinence, rectal injury, bladder dysfunction, and loss of erectile function. During active surveillance, 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.

Currently, there are no widely accepted standards for following men enrolled in an active surveillance program. NYU Langone doctors, with support from the National Institutes of Health, are working to develop evidence-based methods for active surveillance.

Our doctors have received funding from the National Institutes of Health to develop evidence-based active surveillance techniques for prostate cancer.

For men who choose active surveillance for prostate cancer, our doctors typically conduct follow-up PSA tests every six months and follow-up MRI and biopsies at intervals determined for each individual. 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 are advised to get an MRI-guided biopsy of the prostate before pursuing this course of action under the supervision of their doctor. You should discuss with your doctor if active surveillance is right for you.

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.