What Is Active Surveillance?

by Ben Ong
Reading Time: 4 minutes

A diagnosis of prostate cancer can wreck your world, leaving you feeling anxious, fearful and uncertain of your future.

While many men lean towards harmful prostate drugs and invasive surgery, recent research has suggested that men could be being overtreated for prostate cancer.  A study published in the Journal of Urology evaluated the emotional distress of patients soon after diagnosis and after a treatment decision. It found that men who felt more anxious about their diagnosis were more likely to choose surgery over active surveillance. This was despite many patients being diagnosed with low-risk prostate cancer.

Although for some men surgery may be necessary, it can also have a number of negative side effects. For those suffering from low-risk prostate cancer, active surveillance could be of great benefit.


What Is Active Surveillance? 

Active Surveillance is a means of monitoring prostate cancer when it hasn’t yet spread outside of the prostate. It is suitable for men with low-risk prostate cancer which has a low risk of spreading (localized prostate cancer). Active Surveillance includes grade group 1 or Gleason 6, a PSA level <10, cancer that is confined to the prostate.

While it has been ingrained in us by doctors to treat a problem with drugs and surgery immediately, alpha blocker drugs, surgery and radiation can have side effects that lessen a person’s quality of life.  A benefit of monitoring low-risk cancer is that you might avoid having unnecessary surgery. In fact, one study of men undergoing active surveillance found that, 15 years later, less than 1% of men developed metastatic disease.


active surveillance prostate cancer



For many men, the idea of not treating a problem straight away might seem strange.  However, while active surveillance does not require treatment, it does involve constant supervision by your doctor and it is a structured program that will involve both tests and check-ups.

Once you have discussed starting active surveillance with your doctor, you will be reviewed in a clinic at 3 months.


  • PSA Test – The PSA Test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. As men age, their PSA naturally increases, and a high PSA is not always indicative of prostate cancer. This test will be done every three months for two years, then every six months from then on.


  • DRE – The doctor might recommend a DRE (digital rectal exam) to further check your prostate. In this procedure, the doctor or nurse feels your prostate through the wall of the rectum by sliding a finger gently into your anus. This is done to feel for any hard or lumpy areas in your prostate, and to get an idea of its size.


  • MRI – An MRI scan creates a detailed image of your prostate and the surrounding tissues. This allows the doctor to check whether there is cancer and how fast the cancer is spreading.


  • Biopsy – During this process, your doctor may suggest a biopsy. This will usually be done when PSA test results are higher than normal or if your doctor detects a prostate problem during your DRE. However, it should be noted that a biopsy can have a number of risk and life-changing side effects, including infection, sexual incontinence and even the spreading of prostate cancer cells.

active surveillance prostate cancer



  • As no surgery is involved you will not experience any dangerous side effects, which could lessen the quality of your life.
  • It will not affect your everyday life as much as surgery or radiation treatment.



active surveillance prostate cancer

  • Some men may feel anxious at the thought of not having treatment and worry about their cancer growing.
  • Your cancer might grow more quickly than expected and become harder to treat – but this is very uncommon.
  • You may need to have more biopsies, which as mentioned, can have a number of risks and uncomfortable side effects.


Active Surveillance vs Watchful Waiting

When searching for information about active surveillance, you may have come across the term watchful waiting. The two are very different and should not be confused with one another. Although both are used as a way to avoid unnecessary treatment, they have their differences.

active surveillance prostate cancer

Active Surveillance- Monitors prostate cancer more closely, involving a range of periodic tests. It is generally recommended for men with low-risk prostate cancer and never for those diagnosed with high-risk cancer. If your results change your doctor will then proceed to discuss treatment options.

Watchful Waiting- Is usually used by men experiencing other health problems, who may be unable to handle surgery or radiotherapy. It can be used in men with both low-risk cancer or men whose cancer has spread (advanced cancer).  It involves fewer tests than active surveillance and is less intensive, more often than not taking place at the GP surgery than a hospital. If you do have treatment in the future, it will aim to control the cancer and manage any symptoms, rather than to cure it.


A diagnosis of prostate cancer can leave you feeling vulnerable, but by taking the right steps and being aware of treatment options, it can be treated. While active surveillance may not be for everyone, if you do have low-risk prostate cancer, it could be a good option.  Before undergoing surgery, which might not be necessary, do your homework and discuss your options with your doctor.

What Is Active Surveillance?
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About Ben Ong

Ben Ong is a best-selling author and widely regarded as one of the world’s leading experts on natural treatments for metabolic conditions such as prostate disease and type 2 diabetes. He founded Ben’s Natural Health and has worked for over 20 years providing a range of high quality, clinically effective, all-natural supplements for BPH, high PSA, high blood sugar, sexual dysfunction, and others.
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  1. Steve Diahy

    BPH – Enlarged Prostate. I have been battling an enlarged prostate, high PSA numbers, and other issues since the day I turned 50. My first blood test when I was 50 showed a 6.8 PSA number. Before knowing about Ben, I had all the tests including a Biopsy, no cancer but suspicious cells. I have been taking all of the supplements that Ben recommends, trying to clean up my diet and I am doing better. PSA is down to 3.87 and although I cut down my number of trips to the bathroom at night, I am still getting up. My stream at night is not great either, I am not emptying my bladder completely. Bottom line is my prostate is still enlarged, and I am not emptying my bladder fully. I refuse to take any medication as I have read of the side effects. My question for Ben is…are there any surgeries to shrink the prostate like Rezum (which uses steam) or laser surgery that is safe? Besides taking supplements, eating clean, and exercising, is there anything else you can recommend to shrink the prostate and to get my bladder to empty completely?

    • Ben Ong

      Hi Steve, its good that you are shying away from prostate drugs as you are correct, they can have a large number of bad side effects. In terms of steam, there is limited research on steam treatment that have shown a reduction in prostate size and improve symptoms. To date, there are no long term studies to determine whether there are any long terms side effects. Though from short term studies, the most common side effects include dysuria, haematuria, hematospermia, symptoms of urgency and UTIS. I would recommend our Prostate Health Program, which consist of 3 prostate healing supplements. If you would like to discuss this in further detail please get in touch on our toll free number +1 888-868-3554 and we’d be happy to advise you. Wishing you good health.

  2. Miguel castillo

    How does one obtain a Gleason score.

    • Ben Ong

      Hi Miguel,

      If you’d like to get your Gleason Score, the best thing to do is speak to your doctor.


  3. Antonio Santos

    It’s been almost two years since my PSA result was elevated. I.m 68 yrs old and my current PSA was 4.6 as of August 14, 2018. My urologist said that I have BPH and the symptoms are mild, and occasionally I have pain around my pelvis but taking my arthritis pill, meloxicam and pelvis exercise alleviate the pain. When I first had seen at the VA medical center? my doctor recommended having Biopsy to ensure it’s not cancer, even though he didn’t find any hard lump during DRE. I found out later after my appointment at the VA, that MRI is another alternative for biopsy, so I cancel my Biopsy schedule. On November 17, 2017, I had MRI at the University of Washington and the result was a PIRADS 2 Low ( clinically significant cancer is unlikely to be present) I wonder if you’re familiar with this finding. Although I still continue to experience some symptoms of BPH, which perhaps my PSA is still elevated? By the way, I purchased your Prostate Health Program and hopefully, that will help to lower my PSA.

    • Ben Ong

      Hi Antonio,

      Thanks for getting in touch.

      4.6 is not too bad for your age, but something to certainly keep an eye on. I would advise regular PSA tests to keep an eye on things, and perhaps yearly checkups for prostate cancer. As for the symptoms, the Prostate Health Program is our most successful way of getting rid of those symptoms. Just make sure your following the advice I outline in my book, All About The Prostate.


  4. Ron

    Ben, you started talking about Hormone Treatment and then you changed. Please let us know more about hormone treatment side effects and why not hormone treatment.

  5. antonio victor

    very informative. Thanks a lot. Enjoy reading all your article.. Just one question- I am on multivitamin , if I order Total Health, Can I take these two ( MVI and Total Health at the same time?. Let me know. Thanks

  6. Frank Baker

    Would a cats can work in getting a good look at the Prostate?

  7. Stephen J. Osgood

    So very true here, the thing is that once you get radiation or have the surgery to take everything out… oh sure, you don’t have the cancer to worry about, HOWEVER, your chances of having enjoyable sex any more are out the stinking window, many marriages are ruined after that… I was ready to kick my urologist’s ass after finding that out! Radiation aftermath leaves you essentially sexless….

  8. Keith Simpson

    I am under active surveillance, if my PSA does rise which of the treatments do you recommend, l would like to avoid invasive surgery but if needs be l will have that. Which treatment has the least side affects.

    • Ben Ong

      Hi Keith, avoid invasive surgery is a good idea as certain surgeries can result in serious side effects. This article looks at the effects of a biopsy and is worth a read http://www.bensprostate.com/prostate-biopsy-safe/ It also explains some of the alternatives, such as PCA3 Test and MRI. If you would like to discuss this in more detail please call our toll free number +1 888-868-3554 and we’d be happy to try and advise you. Wishing you good health.

  9. Robert Mann

    How does one go about lowering the PSA value?

    Is it reasonable to assume that this is possible?

  10. Brian

    I found this article very interesting, doctors tend to scare most men about the numbers that PSA is meant to be, does this PSA number differ in every man? Or is there a safe PSA number? no one informs us what is a safe number? Could you

    • Ben Ong

      Hi Brian,

      Of course. Here are some general PSA level guidelines: 0 to 2.5 ng/mL is considered safe. 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors. 4.0 to 10.0 ng/mL is suspicious, and generally considered an indicator that you are at increased risk of (or possibly have) prostate cancer. Although this is not always the case. Men with high PSAs do not always have prostate cancer, while men with very low PSAs sometimes DO have prostate cancer.

      Hope this helps,

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