Active Surveillance for Prostate Cancer: Tests, Benefits and Risks
Updated: 2 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review
Quick Answer
Active surveillance is a way to manage low-risk prostate cancer with regular checkups and tests instead of immediate surgery, radiation or other treatment. It's for early-stage, slow-growing cancer that hasn't spread beyond the prostate. You'll have regular PSA tests, exams and biopsies or MRI. If the cancer grows, you can start treatment. Delaying treatment doesn't shorten life expectancy.
What the research says
Monitoring had similar cancer death rates to treatment: in the ProtecT trial of 1,643 men followed for 15 years, prostate cancer death was 3.1% with active monitoring versus 2.2% with surgery and 2.9% with radiation, though cancer spread was more common with monitoring (9.4% vs. about 5%), and 24.4% of monitored men never needed treatment (Hamdy FC et al., New England Journal of Medicine, 2023) [2]
Most men on surveillance did well for years: in a Toronto study of 993 men on active surveillance, 1.5% died of prostate cancer, 15-year cancer-specific survival was 94.3%, and 55% were still untreated at 15 years (Klotz L et al., Journal of Clinical Oncology, 2015) [3]
Key takeaways
Active surveillance monitors low-risk prostate cancer instead of treating it right away.
It includes regular PSA tests, exams, biopsies and MRI.
Treatment starts if the cancer grows.
It avoids treatment side effects.
Delaying treatment doesn't shorten life expectancy.
What is active surveillance?
It's different from watchful waiting, which usually involves fewer tests and focuses on easing symptoms. Active surveillance aims to catch growth early so treatment can still cure the cancer. It can continue for life. Sources: [1]
Who it's for
It isn't right for everyone.
Cancer that hasn't spread beyond the prostate.
Cancer that isn't aggressive, based on tumor size, growth and Gleason score.
Men who want to avoid treatment side effects. Sources: [1]
Tests during active surveillance
The schedule depends on your cancer.
Test | How often |
Once or twice a year | |
Digital rectal exam | Once or twice a year |
Every one to five years | |
As needed |
Sources: [1]
Benefits and risks
Talk with your oncologist about what fits you.
Benefits | Risks |
Avoids side effects of surgery and radiation | Treatment may be delayed if the tumor grows |
Protects quality of life | Cancer that grows can spread |
Many men never need treatment | Worry about living with untreated cancer |
Sources: [1, 2, 3]
When treatment starts
If tests show the tumor is growing or spreading, or new symptoms appear, your oncologist will talk with you about treatment, such as a prostatectomy, radiation or focal therapy. Sources: [1]
Outlook
Active surveillance doesn't treat the cancer, but it protects quality of life. If the cancer doesn't grow, life expectancy is likely typical. Some men stay on surveillance for many years. Sources: [1, 2, 3]
When to call your provider
Call if you have new symptoms or your symptoms get worse. Sources: [1]
Conclusion
Active surveillance lets many men with low-risk prostate cancer avoid or delay treatment and its side effects safely. Keeping every checkup is what makes it work.
Keep learning: read about the PSA test and Gleason score.
Frequently asked questions
What is active surveillance?
Monitoring low-risk prostate cancer with regular tests instead of immediate treatment.
Who is it for?
Men with slow-growing cancer confined to the prostate.
Is it the same as watchful waiting?
No. Active surveillance uses more regular testing.
What tests are involved?
PSA tests, rectal exams, biopsies and sometimes MRI.
How often are tests done?
PSA and exams once or twice a year; biopsy every one to five years.
Will it shorten my life?
Delaying treatment doesn't affect life expectancy for low-risk cancer.
What if the cancer grows?
Your oncologist will discuss starting treatment.
How many men choose it?
About 6 in 10 with low-risk prostate cancer.
Will I need treatment eventually?
Not always; many men never do.
Is it stressful?
Some men feel anxious; talk with your care team.
Related Reading
PSA Test: Normal Levels by Age, How to Prepare and What High Results Mean a key monitoring test.
Gleason Score: How Prostate Cancer Is Graded and What Your Score Means how prostate cancer is graded.
Prostate Ultrasound and Biopsy: Why It's Done, How to Prepare, What to Expect and Recovery checking prostate tissue.
Prostatectomy: Types, Surgery, Risks and Recovery surgery if treatment is needed.
Focal Therapy for Prostate Cancer a targeted treatment option.
References
Cleveland Clinic. Active Surveillance for Prostate Cancer. Cleveland Clinic. Last updated May 12, 2025. https://my.clevelandclinic.org/health/treatments/active-surveillance
Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. New England Journal of Medicine. 2023;388(17):1547-1558. PMID 36912538. https://doi.org/10.1056/NEJMoa2214122
Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. Journal of Clinical Oncology. 2015;33(3):272-277. PMID 25512465. https://doi.org/10.1200/JCO.2014.55.1192
Medical disclaimer
This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own diagnosis and treatment, and seek emergency care right away for severe or sudden symptoms.
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