Active surveillance is a new concept gaining popularity in prostate cancer as well as other types of cancer. It arises out of findings from autopsy studies and studies examining the natural history of prostate cancer that prostate cancer is highly prevalent but not always lethal. Most patients with cancer in their prostate die from other causes rather than the cancer itself. Therefore, older patients, sicker patients, or those with low risk for progression may do well with a period of observation. This entails close monitoring of the PSA, regular prostate exams, and periodic biopsies. Studies have shown that over half of patients enrolled will never be treated. If the disease does progress, radical therapy may then be offered. Most cases are still curable at this point.

Active surveillance has been proven safe in large scale studies with an eight year cancer-specific survival of over 99%. The major benefit of a period of observation is the avoidance of potentially untoward treatment side effects (i.e., impotence and incontinence). We offer active surveillance for patients in the low risk category of prostate cancer. Patients need to commit to close monitoring over time. William Beaumont Hospital has also been designated as a center for the new START trial – an international trial randomizing patients to either active surveillance or radical therapy. You may ask your physician if this trial is right for you.