Active Surveillance for Prostate Cancer
Active Surveillance (AS) is a safe, guideline-supported approach for many men with low-risk, localized prostate cancer. It’s also the most common initial strategy in this group—preserving quality of life while we monitor closely and act only if the cancer shows signs of change.
Educational content only; not a substitute for medical advice.
What Is Active Surveillance?
Active Surveillance is an active monitoring plan for cancers that appear unlikely to grow or spread quickly. Instead of immediate whole-gland treatment (surgery or radiation), we follow a structured schedule of tests to track stability. If there’s meaningful change in grade, volume, or imaging, we pivot promptly to curative therapy.
Reassurance: For appropriately selected men with low-risk prostate cancer, long-term studies show the risk of metastasis or death remains low when AS is performed rigorously.
Who Is a Good Candidate?
Typical Clinical Features
- Biopsy: Grade Group 1 (Gleason 3+3) or very select favorable intermediate-risk
- PSA generally <10 ng/mL and favorable PSA density
- Limited tumor volume and reassuring MRI
Personal Fit
- Comfortable with follow-up testing
- Prefer to preserve urinary and sexual function now
- Open to treatment later if the cancer changes
How We Refine Risk
Pathology
- Gleason score / Grade Group from biopsy
- Core involvement (number and % involvement)
- Tumor location and overall volume
PSA & Imaging
- PSA level & trend (velocity)
- MRI of the prostate (PI-RADS) and prostate volume for PSA density
Genomic Scoring
- MDxHealth GPS (Genomic Prostate Score) or similar panels
- Helps confirm who is a strong candidate for AS vs. who may benefit from earlier treatment
Our Monitoring Plan
PSA Screening
- Once yearly in most men
- No DRE in our standard protocol
MRI of the Prostate
- Every year to reassess known areas and detect new lesions
- Guides targeted sampling when needed
Biopsy Strategy
- Every 1–2 years depending on prior results and risk
- Targeted + systematic cores to avoid missing significant disease
Safety net: Any upgrade in grade group, increasing volume, worrisome MRI, or concerning PSA kinetics prompts discussion of curative options.
Why Waiting Can Be Wise
Preserves Quality of Life
- Avoids or delays urinary and sexual side effects of whole-gland therapy
- Minimal disruption to daily routine
Future-Ready Options
- Emerging focal therapies (e.g., Pulsed Electrical Field Ablation, histotripsy) aim to treat precisely while preserving function
- AS keeps you eligible to consider these as evidence and availability grow
When We Recommend Treatment
Triggers for Intervention
- Biopsy upgrade (e.g., to Grade Group ≥2)
- Rising tumor volume or new suspicious MRI features
- PSA changes suggesting higher-risk biology
Curative Options at That Time
- Robotic prostatectomy with our high-volume surgical team
- Radiation therapy (external beam and/or brachytherapy)
- Focal therapies in select cases (eligibility and coverage vary)
FAQs
Is Active Surveillance really safe?
Yes. For properly selected low-risk patients, AS is safe and the most common starting approach. With scheduled monitoring, the risk of spread or death is low.
Will I miss my chance for a cure?
No. AS is designed to detect meaningful change early. If your cancer evolves, we pivot quickly to curative treatment.
Do I need a DRE?
Not in our standard protocol. We focus on PSA trends, MRI findings, and biopsy results to guide decisions.
How do genomic tests help?
Scores like MDxHealth GPS add biological insight beyond PSA and biopsy, helping confirm suitability for AS—or signaling that earlier treatment may be wiser.
Why Choose Advanced Urology
- Experienced prostate cancer team and high-quality imaging
- Structured AS protocols with clear “action thresholds”
- Access to surgical, radiation, and focal options if needed
- Fast coordination of MRI, biopsies, and follow-up
- Personalized plans balancing cancer control and quality of life
- Transparent discussions about emerging therapies and coverage