What Is Active Surveillance? Does Every Prostate Cancer Require Surgery?
Receiving a diagnosis of prostate cancer after a biopsy can be concerning for many men. However, one of the most important developments in prostate cancer treatment today is that the same treatment is not applied to every patient and unnecessary treatments can be avoided.
One of the first questions many patients ask is:
“I have prostate cancer. Do I need surgery immediately?”
The answer is not always “yes.”
Because some prostate cancers progress very slowly and can be monitored for many years without causing harm to the patient.
This approach is known as Active Surveillance.
What Is Active Surveillance?
Active surveillance is a method of closely monitoring the disease in suitable patients with low-risk prostate cancer instead of immediately performing surgery or radiotherapy.
The aim here is not to refuse or delay treatment.
The aim is to keep the disease under control while avoiding unnecessary treatments.
If the disease shows signs of progression, treatment can be applied at the appropriate time.
Is Every Prostate Cancer the Same?
No.
Prostate cancers can differ significantly in terms of their biological behavior.
Some tumors:
- Grow very slowly
- May not show progression for years
- May not affect the patient’s life expectancy
Others may behave more aggressively and require active treatment.
For this reason, the treatment decision should be made individually.
Who Is a Suitable Candidate for Active Surveillance?
Many factors are evaluated when deciding on active surveillance.
In general:
- Low-risk prostate cancer
- Low tumor volume
- Low PSA level
- Grade Group 1 (Gleason 3+3)
- Suitable MRI findings
are favorable criteria for active surveillance.
However, every patient should be evaluated individually.
Is Active Surveillance the Same as Waiting Without Doing Anything?
Absolutely not.
This is one of the topics most commonly misunderstood by patients.
Active surveillance does not mean “wait and see.”
On the contrary, it requires a planned and regular follow-up program.
During this follow-up, the disease is closely monitored.
What Tests Are Performed During Active Surveillance?
Although the follow-up program may vary depending on the patient, it generally includes:
- Regular PSA measurements
- Digital rectal examination
- Multiparametric prostate MRI examinations
- Repeat biopsies when necessary
The aim is to detect possible changes in the disease at an early stage.
Is Active Surveillance Safe?
Yes.
When appropriate patient selection is made, active surveillance is a safe approach accepted in international guidelines today.
Numerous scientific studies have shown that active surveillance provides successful results in suitable patients with low-risk prostate cancer.
The most important point here is not to miss regular follow-up appointments.
When Is Active Treatment Started?
Some changes may be detected during follow-up.
For example:
- Significant change in PSA increase rate
- Progression in MRI findings
- Detection of higher-grade cancer in repeat biopsies
- Increase in tumor volume
In such cases, active treatments may be considered.
These treatments may include:
- Robotic radical prostatectomy
- Radiotherapy
- Other appropriate options
Can Active Surveillance Cause the Cancer to Spread?
This question is frequently asked by patients.
When appropriate patient selection and regular follow-up are performed, active surveillance has not been shown to cause uncontrolled spread of cancer.
The aim is to continuously monitor the disease and intervene in time when necessary.
Should Every Low-Risk Patient Prefer Active Surveillance?
No.
The treatment decision is not made only according to tumor characteristics.
The patient’s:
- Age
- General health condition
- Expectations
- Anxiety level
- Lifestyle
should also be taken into account.
While some patients may prefer active surveillance, others may choose to receive treatment.
Conclusion
Receiving a diagnosis of prostate cancer does not always mean that surgery or radiotherapy is required.
In suitable patients, active surveillance is a çağdaş and scientific approach that allows the disease to be monitored safely while avoiding unnecessary treatments.
Many patients with low-risk prostate cancer can be followed for years with a high quality of life.
If you have been diagnosed with prostate cancer, it is important to evaluate all your treatment options in detail with an experienced urology specialist in order to determine the most appropriate approach for you.
Assoc. Prof. Dr. Serdar Yalçın
Urology Specialist
Prostate Cancer • Active Surveillance • MRI Fusion Prostate Biopsy • Robotic Urology • Urologic Oncology