Between 12 and 13 percent of men will be diagnosed with prostate cancer. For those with low-risk disease, the National Comprehensive Cancer Network (NCCN) says that active surveillance is preferable to surgery or radiation, but many men and their doctors are not following the NCCN guidelines.

“Studies show that the safest and best treatment for men with low-risk prostate cancer is active surveillance, but in the United States, about 50 percent of men are still being treated with surgery or radiation therapy,” says Minhaj Siddiqui, MD, associate professor of urology at the University of Maryland School of Medicine and director of urologic oncology at the Baltimore VA Medical Center.

What is low-risk?

Low-risk prostate cancer grows very slowly or does not grow at all. It is the most common type of prostate cancer. Ten years after diagnosis, 99 percent of men with low-risk prostate cancer will not have died from it.

You may have low-risk cancer if:

  • The cancer is found on only one side (lobe) of your prostate.
  • The cancer takes up less than half the lobe.
  • The cancer cells are not aggressive, which means they do not have a lot of cell changes seen under a microscope. This is called a low Gleason score.
  • The cancer has not spread outside of the prostate.

Active surveillance

Active surveillance means keeping an eye on your cancer to make sure it does not act up. As recommended by the American Society of Clinical Oncology, surveillance may include a PSA blood test every three to six months, a digital rectal prostate exam at least once per year, and a prostate biopsy in six to 12 months followed by another biopsy every two to five years. If any of these exams suggest an increased risk, active treatment may be recommended.

A 2021 study published in The Journal of Urology followed close to 7,000 men who were diagnosed with prostate cancer. Sixty-eight percent were diagnosed with low-risk prostate cancer. After almost seven years of active surveillance, only one-third had converted to active treatment. The survival rate of prostate cancer is 99 percent with either active surveillance or treatment.

“The only part of surveillance that men complain about is the biopsies,” explains Dr. Siddiqui. “There are ongoing studies to find out if we can reduce the frequency of biopsies.”

Some surveillance programs also include occasional MRI imaging studies. After age 75, men can consider going off active surveillance if their cancer risk has remained low.

If your urologist does not offer active surveillance as the preferred choice for low-risk cancer, you should get a second opinion. “Don’t be afraid to ask,” says Dr. Siddiqui. “I always recommend a second opinion for any cancer diagnosis.”

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