Active surveillance
Some younger men with low risk cancer may prefer to delay their choice of treatment until it is clear that treatment is needed to cure the disease. This approach aims to maintain sexual function for longer and avoid side effects. It is only recommended for men with low risk cancer (see Table 1) or men with other significant life-threatening health issues.
Men on active surveillance have a PSA test every 3–6 months and may have biopsies. Treatment is often recommended if the PSA increases significantly, the biopsy Gleason increases to 7 or more or the cancer grows significantly in size. If this occurs, it still may be possible to have surgery or radiotherapy.

The disadvantage of active surveillance is that no-one can be certain if or when the cancer has progressed to a point when cure is not possible. It is an option you can discuss with your doctor(s).
Observation but no active treatment

(Watchful Waiting)
Some men with slow growing cancers will not have symptoms of the disease in their lifetime. Men over the age of 75 years or who have fewer than 10 years life expectancy may not be affected by their cancer even with no treatment and therefore will not benefit from having treatment. Men on a watchful waiting program can be offered hormone treatment to control the cancer if and when it progresses. This is an option for older men or those with other serious illnesses.
Table 1: Assessing risk



Risk Stage, Gleason score and PSA Chance prostate cancer is confined to the prostate
Low Gleason 2–6
PSA less than 10
Cancer can’t be felt or is felt
in only a small area
Medium Gleason 7
PSA 10–20
Cancer can be felt in a larger area
High Gleason 8–10
PSA greater than 20
Cancer can be felt extending outside the prostate



National Cancer Helpline: 13 11 20
This information sheet is not intended to take the place of medical advice. Information on prostate disease is constantly being updated. We have made every effort to ensure that information was current at the time of production; however your GP or specialist may provide you with new or different information that is more appropriate to your needs.

© Repatriation General Hospital, 2017.