Monitoring prostate cancer

• A quick guide to what's on this page
• What monitoring is
• Why doctors use monitoring
• The difference between active surveillance and watchful waiting
• Active surveillance
• Watchful waiting
• How you may feel
• What you can do for yourself

Monitoring means keeping a close eye on you medically. You don't have any treatment straight away. Your doctor monitors you with regular tests, to see how your prostate cancer behaves. You can start treatment straight away if there is any sign that your cancer is beginning to change or grow.

Your doctor may refer to monitoring prostate cancer as 'active surveillance' or 'watchful waiting'. Some doctors use these terms to mean the same thing. But they are actually used in different situations. So we have covered them separately on this page.

Prostate cancer specialists use monitoring because they know that some men with prostate cancer will never need treatment. Prostate cancer is generally a disease affecting older men. Some prostate cancers develop quite quickly (over a few years) and many develop very slowly. We know from post mortems that most older men who have died from other causes also have signs of prostate cancer. They had not had any symptoms from the cancer and did not know they had it.

It is difficult for doctors to tell whether a prostate cancer is going to grow quickly or slowly. Blood tests and scans can now detect prostate cancer earlier and earlier. So when doctors diagnose a prostate cancer from tests, they may want to wait to see whether the cancer is going to develop, rather than giving treatment straight away. In this way, they can avoid unnecessary side effects that could seriously affect your quality of life.

All cancer treatment has side effects. Apart from the immediate side effects when going through treatment, some men have long term problems after prostate cancer treatment, such as urine leakage (incontinence) or difficulty getting an erection (impotence). Obviously it's best to avoid these risks if at all possible.

The regular blood tests and checks during active monitoring mean that your doctors will pick up any growth of the cancer and then you can have appropriate treatment.

Some doctors use these terms as if they mean the same thing. But they are slightly different. In a nutshell, you are having 'active surveillance' if your doctor intends you to have radical treatment to try and cure your prostate cancer if it starts to grow.

Watchful waiting means keeping treatment to control prostate cancer in reserve, because you aren't having any symptoms. Either your cancer is locally advanced and is likely to be too far grown to cure. Or you have other medical conditions that mean you are not fit enough for radical surgery or radiotherapy. Doctors keep treatment in reserve because you may never need it if your cancer does not cause you any problems. And so that your prostate cancer is controlled for as long as possible - prostate cancers can develop resistance to treatment so it is best not to start it before you have to.

You may have active surveillance if you are diagnosed with localised prostate cancer that may never need treatment. Your specialist will take into account

• Your PSA test results
• How the prostate cancer cells look under a microscope (the Gleason score)
• The size of your prostate gland
• Your views on having treatment and when

You usually go to the hospital for regular appointments and have

• Blood tests every 1 or 3 months to monitor your PSA levels
• Regular digital rectal examinations
• Prostate biopsies every 2 to 3 years

At each appointment, your doctors will also ask if you have developed any new symptoms. If you do develop symptoms, or if your test results show that the cancer is starting to grow, you can have either surgery to remove the prostate gland or radiotherapy to the prostate to try to cure it.

You may have watchful waiting if you

• Have locally advanced prostate cancer with no symptoms
• Have prostate cancer with no symptoms and have other medical problems that mean you can't have radical treatment

Although these decisions are never based only on age, it is generally more likely that much older men will have watchful waiting. Because prostate cancers can grow slowly, an early prostate cancer is less likely to be your cause of death if you are already over 80 years old, for example. And unfortunately, older men are more likely to have other conditions that make them less fit. But of course, if you are a very fit over 80 year old with an early prostate cancer and feel strongly that you want to have immediate treatment, your doctor will be supportive.

Generally, watchful waiting involves fewer tests than active surveillance. You will still have regular appointments, blood tests and examinations. But you are less likely to have regular prostate biopsies. Your doctor may suggest that you have a bone scan.

You can discuss with your doctor how often you need tests. Specialists recommend PSA testing at least every year. You may be able to have your monitoring done at your GP surgery instead of having to go back to the hospital for every appointment.

If you develop symptoms, your specialist is likely to suggest hormone treatment to shrink and control the cancer.

Some people find it very stressful to know they have a cancer and not to get any treatment straight away. Firstly, do have a conversation with your doctor about what they are suggesting. Talk over with them what will happen if the cancer starts to grow. As we've said, the terms 'active surveillance' and 'watchful waiting' can be used in different ways. So the only way to be sure you fully understand is to talk it through in detail.

Once you know what is being suggested, do feel that you can talk to your doctor about how you feel about monitoring. You may feel reassured when your doctor explains how often you will have checks and what the treatment options may be.

During monitoring, there are some things you can do which may help to keep you healthy and will help you to feel you are doing something positive

• Eat a healthy diet
• Learn to relax if you can
• Stop smoking - smoking is not related to prostate cancer, but it is to many other cancers as well as heart disease and lung disease
• Take notice of any new symptoms and report them to your doctor

There is no strong evidence of specific links between diet and prostate cancer. But we know in general that a diet high in fresh fruit and vegetables and fish, and lower in animal fats is better for your health. It is certainly good for your heart and won't do you any harm as far as your prostate cancer is concerned.

Again, hard evidence linking stress to cancer has not been found. But this can be a stressful situation for some people and relaxation will help you feel better and probably cope better too. You could find a new hobby or try relaxation tapes.

Along with stopping smoking, making changes like these to your lifestyle will help you to feel more in control of your situation. You are taking positive steps to improve your health and that is a good thing.