Active surveillance is an option for men whose prostate cancer is considered low risk. Active surveillance means that instead of treatment such as surgery or radiation, we monitor you on a regular basis for signs of more aggressive disease. This means we will test for your levels of prostate-specific antigen (PSA) and perform a digital rectal exam every few months. We may also perform periodic biopsies. Active surveillance is sometimes referred to as “watchful waiting” or “expectant management”, but at Mount Sinai, we prefer the term active surveillance because it is a proactive process, not a passive regimen.
The criteria for being considered “low risk” are not set in stone. Typically, we use the Gleason grade score, a measurement of how “abnormal” the cancerous tissue looks under a microscope. If it looks much like normal prostate tissue, we may assign a grade of 1; the highest grade is 10. Typically, we consider you to be low risk if you have a Gleason grade score of six or below.
Mount Sinai has one of the largest active surveillance cohorts in the country.
The decision to follow an active surveillance protocol is very personal. Some men are uncomfortable with the idea that cancer, no matter how low the risk, is residing in their bodies. Others worry about the potential side effects of treatment (i.e., sexual and urinary side difficulties) and appreciate having this option.