Active Surveillance, also known as "Watchful Waiting," is based on the premise that localized prostate cancer often progresses so slowly that it is unlikely to be a real risk to health during a man's lifetime. The best candidates for watchful waiting are generally men who are older or who have other medical problems, whose tumors are small and slow-growing. Additionally PSA should be less than 10 and Gleason grade needs to be 6 or less.
The active surveillance protocol includes regularly scheduled PSA checks, physical exams (DREs), and occasional repeat prostate biopsy. Any new urinary symptoms or bone pain needs to be reported to their doctor immediately. Typically, those who opt for active surveillance postpone active treatment until the PSA level rises, symptoms develop, or a repeat biopsy shows it is no longer safe to continue the observation protocol.
The main advantage of "watchful waiting" is that it can spare the man with localized cancer the inconveniences and potential side effects of surgery or radiation. On the down side, watchful waiting carries a risk of the cancer spreading (becoming metastatic). Another disadvantage is that many people feel a certain amount of anxiety that comes from living with untreated cancer, the behavior of which is not completely predictable.
Many men who choose watchful waiting live for years with no symptoms or signs of their cancer. Several studies have found that the life expectancy of men on Watchful Waiting (primarily older men with less aggressive prostate cancer) is not substantially different from the life expectancy of men treated with surgery or radiation.
Follow-up for men on an active surveillance protocol includes regular check-ups including PSA and rectal exam. A repeat prostate biopsy 12-18 months after the initial diagnosis is generally recommended. About half of men who opt for Active Surveillance will end up having either surgery or radiation within a few years of their initial diagnosis.