Can active surveillance safely manage prostate cancer cases?

Question

Hello doctor,

I was recently diagnosed with prostate cancer and expected immediate treatment, but instead, my doctor suggested monitoring only. It made me anxious.

Why do doctors sometimes recommend a watchful waiting or active surveillance approach instead of immediate treatment at the age of 63?
How is it safe to leave cancer untreated?
What if it spreads silently while waiting?

I am struggling to trust this approach, even though I have been told that it is low risk. Living with cancer inside me without immediate action feels mentally unbearable, and I need reassurance that this is not neglect.

Kindly advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq. com.

I have read your query and am sorry for the discomfort.

The treatment of prostate cancer depends on many factors. One important management option is active surveillance, which means close monitoring through regular prostate-specific antigen (PSA) testing, follow-up examinations, and monitoring of the Gleason score.

It is important to understand that doctors do not always begin radical treatment immediately just because the condition is called cancer. Prostate cancer is often slow growing, especially when the PSA level is below 10 nanograms per milliliter (ng/mL), and the Gleason score is less than 7. In such cases, there is an opportunity to monitor the tumor closely over time while maintaining careful control of the disease.

Many men with low-risk prostate cancer never see it spread or progress meaningfully. Active surveillance lets you skip treatment and its side effects unless there's a real reason to act.

If the PSA level starts to rise significantly, the Gleason score changes, or there are signs of progression, then other treatment options can be discussed.

At the age of 63, quality of life is also an important consideration. Treatments such as:

Surgery.
Radiation therapy.
Chemotherapy.

May sometimes cause side effects that affect urinary, bowel, or sexual function. For this reason, doctors may prefer careful monitoring unless aggressive treatment becomes necessary.

Sticking to your follow-up schedule and getting tests done on time is what makes active surveillance work. Low-risk prostate cancer rarely spreads suddenly changes usually show up gradually during routine monitoring, well before anything serious develops.

Please do not lose hope or feel that this approach means neglect. Active surveillance is a well-recognized and medically accepted management strategy for selected patients with low-risk prostate cancer.

I hope this is clear, and if you have any questions at any time, please feel free to ask.

Thank you.