Active surveillance is based on the premise that localised prostate cancers may advance so slowly that they are unlikely to cause any problems during the patient’s lifetime. Follow up for patients who opt for active surveillance involves close clinical follow up and regular testing including, 6 monthly PSA, clinical examination and a prostate biopsy every two – three years. Some clinicians are also incorporating MRI scans in their active surveillance protocols. In general small volume, low-grade (Gleason 6) tumours are the cancers most suitable for active surveillance.
Watchful Waiting is recommended for older men whose tumors are small and slow-growing, as judged by a low Gleason score and other diagnostic tests. Follow up generally involves 6 monthly PSA tests and clinical examination.