Being told you have prostate cancer is confronting enough.
Being told you have prostate cancer but that your doctor doesn’t want to treat it straight away can be even harder to get your head around.
For many men, the immediate reaction is:
“Hang on. I’ve got cancer. Why aren’t we doing something about it?”
The answer may be Active Surveillance.
And despite how it might sound, Active Surveillance certainly does not mean ignoring your prostate cancer or simply hoping for the best.
Active Surveillance is a recognised medical approach for monitoring certain prostate cancers that are considered unlikely to cause harm in the immediate future. The aim is to avoid or delay treatments such as surgery or radiation therapy—and their potential side effects—while carefully watching the cancer for any signs that it is changing. (Cancer Council Australia)
What is Active Surveillance?
In simple terms, Active Surveillance means keeping a very close eye on prostate cancer rather than treating it immediately.
Some prostate cancers grow very slowly. In fact, many low-risk prostate cancers may never progress to the point where they threaten a man’s health.
Cancer Council Australia says Active Surveillance is generally used for low-risk prostate cancer that is not causing symptoms, with treatment introduced if testing suggests the cancer is becoming more aggressive.
The Prostate Cancer Foundation of Australia (PCFA) explains that many low-risk prostate cancers never progress and may never require treatment at all. (PCFA Survivorship Kit)
That’s important.
Active Surveillance is not avoiding treatment. It is avoiding treatment until treatment is actually needed.
For some men, that day may arrive.
For others, it may never arrive.
Who might be offered Active Surveillance?
Active Surveillance is most commonly offered to men whose prostate cancer is:
- contained within the prostate
- considered low risk
- low grade
- relatively small in volume
- showing characteristics suggesting that it is unlikely to grow or spread quickly.
Doctors don’t make the decision based on one number.
They look at several pieces of information including your:
PSA level – Prostate Specific Antigen measured through a blood test.
Gleason Score / ISUP Grade Group – an indication of how abnormal and potentially aggressive the cancer cells appear under the microscope.
MRI results – providing information about suspicious areas within the prostate.
Biopsy results – showing the actual cancer cells, their grade and how much cancer has been detected.
PSA Density – which considers your PSA level in relation to the size of your prostate.
PCFA describes typical low-risk Active Surveillance candidates as having ISUP Grade Group 1 disease (Gleason 3+3=6), PSA generally no greater than 10 ng/mL and cancer localised within the prostate. Selected men with favourable Grade Group 2 disease may also sometimes be considered for Active Surveillance. (PCFA Survivorship Kit)
Cancer Council Australia similarly notes that Active Surveillance is usually considered for Gleason 6 / Grade Group 1 cancers and may sometimes be appropriate for selected men with slightly higher PSA levels or some Grade Group 2 cancers. (Cancer Council Australia)
Every bloke is different, though.
Your age, general health, family history, MRI, biopsy findings and other risk factors all need to be considered by your treating specialist.
What actually happens during Active Surveillance?
This is where the word “Active” becomes important.
You’re not sent home and forgotten about.
An Active Surveillance program involves regular medical monitoring, which may include:
- PSA blood tests
- prostate MRI scans
- digital rectal examinations (DRE)
- repeat prostate biopsies
- assessment of PSA density
- occasionally additional biomarker or genomic testing.
Cancer Council Australia says PSA testing may commonly be performed every 3–6 months, with MRI, examination and additional biopsies undertaken according to the individual’s surveillance program. (Cancer Council Australia)
European Association of Urology guidelines also recommend structured follow-up for men on Active Surveillance, including regular PSA testing, clinical assessment, MRI where appropriate and repeat biopsy. (Uroweb)
The exact schedule varies from man to man. So talk to your doctor.
And here’s something else worth understanding:
A rise in PSA doesn’t automatically mean it’s time for treatment.
PSA can move around for several reasons.
Current European guidelines recommend that a significant change in PSA should generally prompt further investigation, such as MRI or biopsy, rather than automatically triggering cancer treatment on the PSA result alone. (Uroweb)
That’s why doctors look at the entire picture rather than one blood-test number.
So when does Active Surveillance stop?
Active Surveillance continues for as long as your medical team believes it remains safe.
If testing starts showing that the cancer has changed, your specialist may recommend moving from Active Surveillance to active treatment.
That might happen because:
- the grade of the cancer increases
- a repeat biopsy shows more significant disease
- the volume of cancer increases
- MRI identifies concerning changes
- other clinical findings suggest progression.
Your own feelings matter as well. Some men are perfectly comfortable living with prostate cancer under Active Surveillance.
Others find the psychological side difficult.
PCFA acknowledges that some men experience increased anxiety or distress while on Active Surveillance, particularly around upcoming PSA tests, scans and biopsies. (PCFA Survivorship Kit)
If you’re struggling with that uncertainty, talk to your GP, urologist or prostate cancer nurse.
Active Surveillance is NOT the same as Watchful Waiting
These terms are sometimes mixed up, but medically they have different meanings.
Active Surveillance generally applies to men with lower-risk cancer where the intention is still potentially curative treatment if the cancer begins to change.
Watchful Waiting is more commonly used when age, other health conditions or life expectancy mean that aggressive treatment may offer little benefit. The focus is generally on managing symptoms if they occur rather than monitoring closely with the intention of eventually providing curative treatment. (Cancer Council Australia)
That’s a significant difference.
Active Surveillance means:
We’re watching it closely and we’ll act if we need to.
What about urinary symptoms during Active Surveillance?
Here’s another point that can become confusing.
Being on Active Surveillance does not itself normally cause urinary leakage or bladder problems. PCFA notes that Active Surveillance doesn’t involve active cancer treatment, so it doesn’t carry the same urinary, sexual and bowel side effects that can occur following treatments such as surgery or radiation therapy. Some short-term effects can occur following procedures such as prostate biopsy. (PCFA Survivorship Kit)
However, men undergoing Active Surveillance can still experience everyday urinary symptoms.
An enlarged prostate, commonly known as Benign Prostatic Hyperplasia (BPH), bladder changes and other urinary conditions can occur at the same time as prostate cancer.
Some men notice things such as:
- needing to urinate more frequently
- urgency
- difficulty completely emptying the bladder
- reduced urinary flow
- a few drips after going to the toilet
- occasional minor leakage.
These symptoms should always be discussed with your doctor, particularly if they are new or changing.
But while you’re getting on with everyday life, there’s also no reason a few annoying drips should dictate what underwear you wear or make you feel uncomfortable throughout the day.
Staying comfortable while on Active Surveillance
At SEAL Underwear, we’re interested in the entire prostate health journey—not simply what happens after surgery.
For some men, that journey can include years of Active Surveillance.
Life continues during those years.
You still work. You still exercise. You still travel.
You still go to the races, play golf, go out for dinner and get on with being yourself.
And if you experience those annoying little urinary drips or dribbles along the way, you may not feel that you’re ready—or even need—to wear a bulky medical continence product.
That’s one of the reasons SEAL – Protection Downunder® washable underwear was developed.
SEAL Performance Daily is designed as normal-looking men’s underwear with discreet built-in protection for everyday minor drips and dribbles.
It’s not a treatment for prostate cancer. It’s not a replacement for medical advice. It’s simply another option for men who want a little extra protection while getting on with their day.
Because whether you’re undergoing tests, living with BPH, on Active Surveillance for prostate cancer, recovering from prostate treatment or simply noticing that the plumbing isn’t quite working the way it used to - life doesn’t stop because your prostate has decided to become part of the conversation.
The most important thing about Active Surveillance
Perhaps the biggest misconception about Active Surveillance is the idea that nothing is happening.
Quite the opposite. You’re watching. Your doctors are watching.
Your PSA is being monitored. Your MRI and biopsy results are being assessed. And if something changes, the aim is to identify that change while there is still an opportunity to act.
For appropriately selected men, Active Surveillance can provide the opportunity to live normally for many years while avoiding—or sometimes completely avoiding—the potential side effects associated with prostate cancer treatment. (PCFA Survivorship Kit)
So if your specialist recommends Active Surveillance for prostate cancer, ask questions.
Understand your PSA. Understand your Gleason Score and Grade Group. Keep your appointments. Keep copies of your results.
And most importantly, don’t interpret Active Surveillance as your doctor doing nothing.
Active Surveillance means exactly what the name says: actively watching your cancer and being ready to act if things change.
Need a little extra protection along the way?
If you’re experiencing everyday minor urinary drips or dribbles, discover SEAL – Protection Downunder®, washable men’s underwear designed to provide discreet everyday protection without making you feel like you’re wearing a medical product.
Life changes. We designed underwear for that.
This article provides general information only and is not medical advice. Active Surveillance programs vary between individuals. Always follow the advice and monitoring schedule provided by your GP, urologist or treating healthcare team.
The medical foundation is strong. Cancer Council Australia’s prostate-cancer guidance was updated on 7 August 2026, so we are working from very current Australian information. PCFA and the European Association of Urology broadly support the same approach: Active Surveillance is standard management for suitable low-risk disease, with selected favourable intermediate-risk men sometimes considered as well.
