Active Surveillance can be different for different men. Your doctor will advise you on your specific Active Surveillance monitoring protocol. It is important to keep track of your appointments and not to miss regular tests that have been scheduled for you.
Active Surveillance will involve:
- PSA testing at regular intervals
- digital rectal examination (DRE) at regular intervals
- MRI prostate scans at regular intervals
- repeat biopsies at regular intervals.
If your test results suggest that your cancer could be growing, you may be offered further tests to check on the cancer. If any changes are found, you could be advised to have active treatment that aims to cure the cancer.
Active Surveillance is continuing to be studied and protocols might change as new evidence becomes available. This could affect which tests are required and how often they need to be repeated. As they are developed, new tests may be offered to help predict whether treatment is needed or not.
Your PSA will be checked at regular intervals. Your PSA level will fluctuate over time, even if your cancer isn’t growing. Your doctor will advise whether you need further tests by looking at the pattern of your PSA changes. A rising PSA is a concern, and your doctor will calculate the PSA velocity and doubling time (how quickly the PSA level is rising and how long it will take for PSA to double). A high PSA velocity and PSA doubling time can indicate that your cancer may be growing.
Digital rectal examination (DRE)
A DRE is when a doctor inserts a gloved, lubricated finger into the rectum (back passage) to feel the size of the prostate and check if there are any abnormalities. Occasionally a cancer can be felt this way, but not always.
Most men will have an MRI scan when they first start Active Surveillance to make sure the cancer hasn’t spread outside the prostate. Your doctor will usually recommend having repeat MRI scans as part of your routine surveillance plan, especially if your PSA test or DRE have changed. The scan will sometimes be done before a biopsy or as an alternative to the repeat routine biopsy.
All men need a biopsy at diagnosis to determine if they are suitable for Active Surveillance. Once you start Active Surveillance, you will require further biopsies. Your doctor will advise you on how often you will need to have a biopsy.
There are new tests being developed that can analyse the genetic makeup of the prostate cancer in the biopsy samples. These tests might help to predict which cancers are more likely to require treatment and which cancers might have an even lower risk of needing treatment. These tests are not routinely recommended now, but they might become a more regular part of Active Surveillance as further evidence becomes available.
Biological markers are molecules found in body fluids such as blood, urine and semen that can show signs of a disease. There are several tests being developed or recently introduced that measure prostate health by analysing biological markers in the urine and semen. There is not enough evidence yet for them to be used to monitor men on Active Surveillance programs.
It’s vital to keep up with routine monitoring of your prostate cancer. If you don’t, you increase the risk that changes to your prostate cancer may not be detected, which could lead to advanced disease and lower prospects for long-term survival.
You can use the table in Section 10 of the Understanding Active Surveillance resource booklet - Tracking your test results on pages 16 and 17 to keep track of your results and the plan for you.