Active surveillance

Active monitoring is the term used for the conservative management of prostate cancer. It is based on a targeted decision by a patient with low-risk prostate cancer not to treat his or her disease, but only to monitor it closely under the supervision of a physician, and to start treatment only when there are well-defined signs of deterioration. The essence of active monitoring is therefore to delay the side effects of radical treatment (burden of surgery, erectile dysfunction, urinary leakage, or radiation-related side effects).

Follow-up includes regular PSA checks (most commonly every three months), examination of the prostate by palpation, and another prostate biopsy after the first year after diagnosis, in order to assess any changes in tumour aggressiveness or the number of affected samples.

The criteria for discontinuation of active surveillance and initiation of active treatment vary, but in particular the reassessment of the cancer from low to intermediate or high risk after repeated biopsy. Your treating physician should consider whether active surveillance is appropriate for you and should inform you of the advantages and disadvantages of active surveillance. You may also decide at any time during the follow-up that you want to stop this regimen and undergo radical treatment.

Active surveillance is for men who would normally be treated with either surgery or radiotherapy but for some reason do not wish to do so themselves after being informed about all the consequences. They are in a certain position in their life where treatment at that moment could bring them side effects, and they have decided that they will only be actively monitored.

Close monitoring

Watchful waiting means that patients are also monitored, as in the case of active monitoring. The difference is that these are usually older patients or those with multiple comorbidities for whom radical treatment would bring more complications than positive effects. Therefore, we try to delay it as much as possible.