Strange as it may seem, most men with early prostate cancer do not need to be treated. Usually, the cancer grows so slowly that the man will live out his natural span, and die of something else before the cancer causes any symptoms. Unfortunately, others may spread to other parts of the body and become life-threatening. At the moment doctors have no good way of telling which will need treatment, and which will not.

There have been two standard approaches to this problem. The first has been to recommend aggressive treatment to all men with early cancer. This means surgery to remove the prostate, or a course of radiotherapy. While this ensures that all the significant cancers are treated, it also means many are treated when they don’t need to be. As the treatment can have major unwanted effects, particularly incontinence and impotence, this is a big problem.

The second approach has been described as watchful waiting. This means that men with early cancer are seen regularly in clinic. If they develop symptoms from progressive prostate cancer, their doctors will start them on hormone therapy. While this approach avoids the side-effects of surgery or radiotherapy, some men needing treatment may not get it. Active surveillance is an alternative approach which aims to identify the few men with early prostate cancer who need to be treated with surgery or radiotherapy, so that the rest are spared the unwanted effects of unnecessary treatment. Men on active surveillance are closely monitored – with a prostate specific antigen (PSA) blood test every few months, and, if they are willing, repeat surgical sampling of the tumour every two years. Those men whose cancer shows signs of progressing receive aggressive treatment. Early results from Canada, based on about 200 selected men with early prostate cancer, suggest that as many as 70% of men on active surveillance will avoid treatment for their prostate cancer. The effect of this approach on their life span has not yet been established. Doctors at the Royal Marsden Hospital are studying active surveillance in men with early prostate cancer. They need to recruit several hundred men. To join this study, which is funded in part by the National Cancer Research Institute Prostate Cancer Collaborative, you must be:

* a man with prostate cancer;
* between the ages of 50 and 80;
* with a Gleason score of 7 or less;
* with a PSA of less than 15;
* who has not yet had treatment;