Questions to Ask your Doctor: While on Active Surveillance

The usage of Active Surveillance or “watchful waiting” has been increasing in frequency over the past few years as an alternative to treatment. Men with a low grade Gleason score (6 or under), low PSA and stage, and a small volume (small amount of cancer found during biopsy), may opt to hold off on treatment to avoid the potential sexual and urinary side effects of radiation or surgery.

If your doctor or treatment team has suggested Active Surveillance, there are a few questions that you should ask.

  • How does Active Surveillance work?
  • What is my current Gleason Score? My PSA?
  • DO I need a second opinion on my biopsy?
  • How often must I be re-checked for examination, rebiopsy, and PSA blood testing?
  • Is there a specific score at which we would re-evaluate my need for treatment?
  • Are there any symptoms that would signal a need to return for a re-check sooner?
  • What dietary or nutrition changes should I make while on active surveillance?
  • What is the ideal exercise program while I am on active surveillance?
  • Is it possible that my cancer will go away?

It’s very important to keep an open line of communication with your doctor and to understand your cancer and treatment decisions fully.

Terms to know from this article:

Active Surveillance

Active surveillance is an option offered to patients with very low-risk prostate cancer (low grade, low stage, localized disease). Patients are monitored carefully over time for signs of disease progression. A PSA blood test and digital rectal exam (DRE) and prostate biopsy are performed at physician-specified intervals. Signs of disease progression will trigger immediate active treatment.


The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.


Gleason Score (GS) - Gleason Grade: A system of grading prostate cancer cells based on how they look under a microscope. Gleason scores range from 2 to 10 and indicate how likely it is that a tumor will spread. A low Gleason score means the cancer cells are similar to normal prostate cells and are less likely to spread; a high Gleason score means the cancer cells are very different from normal and are more likely to spread.


The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.


prostate-specific antigen (PSA): A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate.