Anxiety and distress levels do not change significantly during active surveillance for low-risk prostate cancer, the findings of a small Dutch study suggest.These results are useful to clinicians involved in helping patients in this complex decision making process. The impact of perceived physician involvement in decision making is important and emphasises the need for greater patient involvement. As well as informative literature and interactive technology, prostate cancer specialist nurses can also play a key role. These nurses have been shown to have a hugely beneficial role in helping patients arrive at a management decision.