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The PCaReview: Precision in Progress
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Prostate Cancer Awareness Month Special Edition - September 2026


About PCaReview

This is a monthly publication dedicated to helping patients, survivors, caregivers, advocates, and healthcare professionals better understand prostate cancer through evidence-based education. Every issue translates the latest clinical research into clear, practical information that empowers readers to make informed decisions alongside their healthcare team.

Our editorial philosophy is simple: provide balanced, accurate, and patient-centered information grounded in the best available evidence. We believe that understanding the "why" behind medical recommendations is just as important as understanding the recommendations themselves.

Whether you are newly diagnosed, considering treatment options, living with advanced disease, or supporting someone you love, our goal is to help you navigate the prostate cancer journey with knowledge, confidence, and hope.

Editorial Team

Editor-in-Chief

Jacques Pierre

Voice Edition Narrator

Vince Cefalu

Technical Production

Oryne Stewart


Editor's Perspective

Knowledge Is a Form of Treatment

Few words create as much fear as, "You have cancer."

For generations, the instinctive response has been immediate action. Remove it. Destroy it. Treat it as quickly as possible.

That approach has saved countless lives. Yet one of the greatest advances in modern prostate cancer care has come from recognizing that not every cancer behaves the same way.

Today, physicians understand that many prostate cancers grow very slowly. Some may never threaten a man's life. Others require prompt and aggressive treatment. The challenge lies in distinguishing between the two.

This understanding has fundamentally changed how prostate cancer is managed.

Active surveillance represents one of the clearest examples of precision medicine in everyday clinical practice. Rather than treating every diagnosis immediately, physicians can carefully monitor selected patients whose cancers appear unlikely to progress rapidly. If evidence suggests the cancer is becoming more aggressive, treatment can still be initiated with the intent to cure.

For many patients, this approach offers something that was rarely possible a generation ago: the opportunity to preserve urinary function, sexual health, bowel function, and overall quality of life without compromising long-term cancer outcomes.

Yet active surveillance is often misunderstood.

Some patients worry that surveillance means ignoring cancer. Others fear that waiting will allow the disease to spread beyond cure. Family members frequently ask whether delaying treatment is taking an unnecessary risk.

These are understandable concerns.

The reality is that active surveillance is neither passive nor experimental. It is a carefully structured medical program supported by decades of clinical research, sophisticated imaging technologies, improved pathology, and well-defined monitoring protocols. When recommended for appropriately selected patients and followed consistently, it has become one of the safest and most studied management strategies in prostate cancer.

This issue of The PCaReview explores active surveillance from every angle.

We'll explain how physicians determine whether someone is an appropriate candidate, what monitoring involves, how MRI has transformed surveillance, what research tells us about long-term outcomes, and why quality of life remains central to every treatment decision.

You'll also discover emerging technologies that may further improve surveillance in the coming years, including genomic testing, artificial intelligence-assisted imaging, and more personalized risk assessment.

Our hope is simple.

Whether you are newly diagnosed, currently on active surveillance, considering treatment, or supporting a loved one, we want this issue to help you better understand one of the most important advances in prostate cancer care.

Because informed decisions begin with informed patients.

— Jacques Pierre

Editor-in-Chief


Table of Contents

Editor's Perspective

Knowledge Is a Form of Treatment

Main Feature

Active Surveillance: Choosing Observation Without Compromising Care

Understanding Active Surveillance

Research Spotlight

What Decades of Research Tell Us About Safety

The Role of MRI

How Modern Imaging Changed Active Surveillance

Monitoring Over Time

What to Expect During Active Surveillance

Quality of Life

Living Well While Living With Cancer

Shared Decision-Making

Working With Your Healthcare Team

Nutrition & Lifestyle

Supporting Long-Term Health

Myth vs. Fact

Questions to Ask Your Doctor

Glossary

References


Main Feature

Active Surveillance

Choosing Observation Without Compromising Care

A Different Way to Think About Cancer

Imagine sitting in your doctor's office after weeks of testing.

Your prostate biopsy has confirmed cancer.

Your mind immediately begins racing.

"Do I need surgery?"

"Will I need radiation?"

"How soon can treatment begin?"

Then your physician says something unexpected.

"I don't think you need treatment—not today."

For many patients, this recommendation feels almost impossible to understand.

We've been taught throughout our lives that cancer should be removed as quickly as possible. Waiting can feel frightening, even irresponsible. Friends and family may question why treatment isn't starting immediately. Some patients worry that every day they wait gives cancer an opportunity to spread.

Yet modern prostate cancer research tells a different story.

Not every prostate cancer behaves aggressively.

Some tumors grow rapidly and require immediate intervention. Others grow so slowly that they may never cause symptoms or shorten a person's life. Learning to distinguish between these different types of prostate cancer has become one of the most significant achievements in modern urologic oncology.

That understanding gave rise to active surveillance.

Rather than treating every prostate cancer immediately, physicians can now identify carefully selected patients whose cancers appear unlikely to become dangerous in the near future. Instead of surgery or radiation, these patients enter a structured monitoring program designed to detect meaningful changes early—while preserving the opportunity for curative treatment if it becomes necessary.

This approach has transformed the lives of thousands of men around the world.

For many, active surveillance means avoiding years—or even decades—of urinary incontinence, erectile dysfunction, bowel complications, and other treatment-related side effects without increasing the risk of dying from prostate cancer.

Perhaps most importantly, active surveillance recognizes something increasingly understood throughout medicine: the best treatment is not always the earliest treatment. Sometimes the most appropriate care is careful observation supported by science, advanced imaging, regular monitoring, and shared decision-making.

Choosing active surveillance is not choosing to ignore cancer.

It is choosing a different strategy—one that balances cancer control with quality of life.


Why Active Surveillance Was Developed

Before widespread prostate-specific antigen (PSA) testing became common, prostate cancer was often diagnosed only after symptoms developed. Many cancers discovered at that stage were already more advanced, making immediate treatment the obvious choice.

The introduction of PSA screening dramatically changed this landscape.

Physicians began identifying prostate cancers years earlier than ever before. While early detection undoubtedly saved lives, it also revealed another reality: many of these newly discovered cancers appeared unlikely to become life-threatening.

Researchers noticed that numerous men underwent surgery or radiation for cancers that might never have caused problems during their lifetime. Although treatment was successful in controlling the disease, many patients experienced long-term side effects affecting urinary control, sexual function, and bowel health.

This raised an important question.

Could some patients safely delay treatment while still maintaining an excellent chance of cure if their cancer eventually showed signs of progression?

Over the past two decades, research from institutions such as the National Cancer Institute, Johns Hopkins Medicine, Memorial Sloan Kettering Cancer Center, the University of Toronto, and other leading centers has helped answer that question.

The evidence now demonstrates that for carefully selected patients with low-risk prostate cancer—and some men with favorable intermediate-risk disease—active surveillance can provide outstanding long-term cancer-specific survival while substantially reducing unnecessary treatment.

In other words, physicians have learned that immediate treatment is not always synonymous with better treatment.

Instead, modern prostate cancer care increasingly emphasizes matching treatment intensity to the biology of the disease rather than treating every diagnosis the same way.


What Active Surveillance Really Means

One of the most common misconceptions is that active surveillance means "doing nothing."

Nothing could be further from the truth.

Active surveillance is a structured medical program that requires commitment from both the patient and the healthcare team.

Although surveillance protocols vary somewhat among medical centers, most programs include regular PSA testing, digital rectal examinations when appropriate, multiparametric MRI, repeat prostate biopsies, and ongoing clinical assessments.

Each appointment provides another opportunity to answer a critical question:

Has the cancer changed enough to justify treatment?

If the answer remains no, surveillance continues.

If evidence suggests that the cancer has become more aggressive, physicians can recommend curative treatment while the disease is still believed to be confined to the prostate.

This continuous process of reassessment allows patients to avoid or delay treatment-related side effects without abandoning the opportunity for cure.


PCaReview Key Takeaways


Understanding Active Surveillance

Who Is a Candidate and How Physicians Determine Risk

One of the first questions many patients ask after learning about active surveillance is, "Am I a candidate?" The answer depends on much more than a single PSA result or biopsy report. Physicians evaluate multiple pieces of information together to estimate how likely the cancer is to remain slow-growing or become more aggressive over time.

Today's approach to active surveillance reflects the principles of precision medicine. Rather than treating every patient the same, clinicians tailor recommendations based on the biology of the cancer, the patient's overall health, life expectancy, personal preferences, and ability to participate in long-term monitoring.

The goal is simple: identify patients who can safely avoid or delay treatment while ensuring that those whose cancers become more aggressive receive timely intervention.


Understanding Risk Categories

One of the most important concepts in prostate cancer care is risk stratification—the process of estimating how likely a cancer is to grow, spread, or affect survival.

Risk categories help physicians recommend the most appropriate management strategy.

Although guidelines differ slightly among organizations, prostate cancer is generally classified into:

Active surveillance is most commonly recommended for very low-risk and low-risk prostate cancer. Some carefully selected men with favorable intermediate-risk disease may also be appropriate candidates after detailed discussion with their healthcare team.

Risk classification considers several factors together, including:

No single test determines whether active surveillance is appropriate. Instead, physicians look for patterns across all available information.


Grade Groups: Understanding Cancer Aggressiveness

One of the strongest predictors of prostate cancer behavior is the Grade Group, which is based on the Gleason grading system.

A pathologist examines prostate tissue under a microscope and evaluates how abnormal the cancer cells appear compared with healthy prostate tissue.

The more abnormal the cells look, the more likely the cancer is to grow aggressively.

Grade Group 1 (Gleason Score 3+3=6)

This represents the lowest grade of prostate cancer currently diagnosed.

Most men offered active surveillance fall into this category because these cancers generally grow slowly and have a very low likelihood of spreading when appropriately monitored.


Grade Group 2 (Gleason Score 3+4=7)

This group contains mostly low-grade cells with a smaller amount of higher-grade cancer.

Some carefully selected men with Grade Group 2 disease may still qualify for active surveillance, particularly when MRI findings are reassuring and only a small amount of cancer is present.


Grade Group 3–5

These cancers contain increasing amounts of aggressive cancer cells.

Immediate treatment is generally recommended because the likelihood of progression is significantly higher.


What This Means for You

Many patients hear the word "cancer" and assume every diagnosis carries the same level of danger.

It doesn't.

Knowing your Grade Group helps you understand how your cancer compares with others and why your physician may recommend surveillance instead of immediate treatment.


PSA: More Than Just a Number

The prostate-specific antigen (PSA) blood test remains one of the most valuable tools for monitoring prostate cancer.

However, PSA should never be interpreted in isolation.

Many conditions besides cancer can increase PSA, including:

For this reason, physicians focus less on a single PSA result and more on how PSA changes over time.

Important concepts include:

PSA Trend

Has PSA remained stable?

Is it slowly increasing?

Has it risen rapidly?

Patterns often provide more information than individual numbers.


PSA Velocity

This measures how quickly PSA changes over time.

Rapid increases may prompt additional testing but do not automatically mean the cancer has progressed.


PSA Density

PSA density compares PSA level to prostate size measured on MRI or ultrasound.

A larger prostate naturally produces more PSA.

Two men with the same PSA level may have very different PSA density depending on prostate volume.

Research suggests PSA density may improve patient selection for active surveillance.


What This Means for You

Don't panic if one PSA test is slightly higher than the last.

Your physician will interpret PSA together with MRI findings, biopsy results, physical examination, and previous PSA values before recommending any changes.


The Role of MRI

Few advances have transformed active surveillance more than multiparametric MRI (mpMRI).

Before MRI became widely available, physicians relied primarily on systematic biopsies.

Although effective, biopsies sample only a small percentage of the prostate.

Small aggressive tumors could occasionally be missed.

Modern MRI helps physicians identify suspicious areas that deserve closer evaluation.

MRI allows doctors to:

MRI has significantly improved physicians' confidence when recommending active surveillance.


Understanding PI-RADS

MRI findings are often reported using the PI-RADS scoring system.

Scores range from:

PI-RADS 1

Highly unlikely to represent clinically significant cancer.

PI-RADS 2

Low likelihood.

PI-RADS 3

Intermediate or uncertain.

PI-RADS 4

High likelihood.

PI-RADS 5

Very high likelihood of clinically significant cancer.

MRI findings are always interpreted together with biopsy and PSA—not independently.


MRI Doesn't Replace Biopsy

Patients often ask:

"If MRI looks normal, why do I still need another biopsy?"

It's an excellent question.

Although MRI has dramatically improved prostate cancer detection, it cannot identify every microscopic focus of aggressive disease.

Repeat biopsies remain an important part of most surveillance programs because they provide direct tissue confirmation.

Many surveillance programs now combine MRI with targeted biopsy and systematic biopsy, providing a more complete assessment than either test alone.


Active Surveillance vs. Watchful Waiting

Active Surveillance

A Structured Monitoring Approach with Curative Intent

Active surveillance is a carefully planned management strategy for men with low-risk or selected favorable intermediate-risk prostate cancer. Rather than treating the cancer immediately, the goal is to monitor it closely while preserving the opportunity for curative treatment if there is evidence that the cancer is becoming more aggressive.

Patients enrolled in an active surveillance program undergo regular follow-up visits that may include PSA testing, digital rectal examinations (DRE), multiparametric MRI (mpMRI), and repeat prostate biopsies. These tests help physicians identify signs of disease progression early, allowing treatment to begin while the cancer is still potentially curable.

Active surveillance is most commonly recommended for patients who are otherwise healthy, have a longer life expectancy, and have cancer characteristics that suggest a low likelihood of rapid progression.

Key Characteristics


Watchful Waiting

A Symptom-Focused Management Approach

Watchful waiting is a less intensive management strategy typically recommended for men with limited life expectancy, advanced age, or significant medical conditions where the potential benefits of curative treatment are unlikely to outweigh the risks.

Unlike active surveillance, watchful waiting does not involve regular testing designed to detect cancer progression. Instead, the focus is on monitoring for symptoms and maintaining quality of life. Treatment is generally initiated only if symptoms develop and is aimed at relieving discomfort or controlling disease-related complications rather than curing the cancer.

This approach recognizes that, for some patients, prostate cancer may progress so slowly that it is unlikely to become the primary health concern during their lifetime.

Key Characteristics

What This Means for You:

Although both approaches delay immediate treatment, they are not the same. Active surveillance is an organized, evidence-based strategy designed to detect changes early so that curative treatment remains an option. Watchful waiting, in contrast, focuses on comfort and quality of life, with treatment directed toward relieving symptoms if they arise. Choosing between these approaches depends on your cancer characteristics, overall health, life expectancy, and personal preferences after discussing your options with your healthcare team.


Research Spotlight

How Safe Is Active Surveillance?

More than twenty years of research from major academic medical centers has demonstrated excellent long-term outcomes for carefully selected men undergoing active surveillance.

Large prospective studies consistently report:

Importantly, patients who eventually require surgery or radiation after surveillance often continue to achieve outcomes similar to those treated immediately, provided progression is identified early through regular monitoring.

These findings have helped establish active surveillance as the preferred initial management strategy for many men with low-risk prostate cancer.


PCaReview Key Takeaways


Questions to Ask Your Doctor


Living with Active Surveillance

A Journey of Monitoring, Confidence, and Partnership

Receiving a recommendation for active surveillance can bring mixed emotions. For some men, it is a tremendous relief to learn that immediate treatment may not be necessary. For others, it creates a new kind of anxiety: living with a known cancer while waiting to see whether it changes.

These reactions are completely understandable.

Unlike surgery or radiation, active surveillance does not offer the psychological reassurance of feeling that the cancer has been "removed" or "destroyed." Instead, it requires trust in a carefully designed monitoring program and confidence in the evidence supporting this approach.

For many patients, active surveillance becomes more than a treatment strategy—it becomes a long-term partnership with their healthcare team. Each PSA test, MRI, and follow-up visit provides another opportunity to confirm that the cancer remains stable or to identify changes early enough for curative treatment.

Rather than living in fear, many patients gradually come to view surveillance as a proactive and empowering way to manage their health.


What Does Active Surveillance Look Like?

Although surveillance schedules vary between institutions and are individualized to each patient, most programs follow a structured pattern.

At Diagnosis

Your healthcare team will review:

This information helps determine whether active surveillance is an appropriate option.


During the First Year

Most patients will have:

The confirmatory biopsy is especially important because it helps ensure that a higher-grade cancer was not missed during the initial biopsy.


Long-Term Monitoring

If the cancer remains stable, surveillance generally continues with:

Surveillance schedules are not identical for every patient. Factors such as age, MRI findings, PSA trends, and previous biopsy results may influence how frequently testing is recommended.


What Happens If Something Changes?

One of the greatest strengths of active surveillance is that it is designed to identify meaningful changes before the cancer becomes difficult to treat.

Possible reasons for recommending treatment include:

It is important to remember that one abnormal test rarely leads directly to treatment.

Instead, physicians often look for confirmation across multiple tests before recommending surgery, radiation therapy, or another treatment approach.


Research Spotlight

The ProtecT Trial: A Landmark Study

One of the most influential studies in localized prostate cancer is the ProtecT (Prostate Testing for Cancer and Treatment) Trial, conducted in the United Kingdom.

The study compared three initial management strategies:

Participants were followed for many years to evaluate survival, disease progression, and quality of life.

One of the study's most important findings was that prostate cancer-specific mortality remained very low across all three groups during long-term follow-up.

However, men who underwent surgery or radiation experienced significantly higher rates of treatment-related side effects, particularly urinary, bowel, and sexual complications.

The study also demonstrated that active monitoring required careful follow-up because disease progression occurred more frequently than with immediate treatment. Nevertheless, many men remained free from treatment for years while preserving their quality of life.

The ProtecT Trial reinforced an important message:

For carefully selected patients, delaying treatment does not necessarily mean compromising survival.

Instead, it provides an opportunity to balance cancer control with quality of life through careful monitoring and timely intervention when needed.


Decades of Experience

The ProtecT Trial is only one part of a much larger body of evidence.

Long-term active surveillance programs from institutions such as Johns Hopkins Medicine, Memorial Sloan Kettering Cancer Center, the University of Toronto, and other leading centers have followed thousands of patients over many years.

These studies consistently demonstrate that:

These findings have helped establish active surveillance as the preferred initial management strategy for many men with low-risk prostate cancer.


Quality of Life Matters

One of the primary goals of active surveillance is preserving quality of life.

Surgery and radiation therapy can be life-saving treatments, but they may also affect:

For patients whose cancers are unlikely to progress rapidly, avoiding these side effects can represent a meaningful improvement in long-term well-being.

Quality of life extends beyond physical health.

Maintaining employment, caring for family, participating in hobbies, traveling, exercising, and enjoying intimate relationships are all important aspects of survivorship.

Active surveillance allows many patients to continue living their lives with minimal disruption while remaining under careful medical supervision.


The Emotional Side of Surveillance

Although active surveillance avoids many physical side effects, it introduces emotional challenges that deserve equal attention.

Many patients experience what clinicians sometimes call "PSA anxiety."

Waiting for laboratory results every few months can be stressful.

Questions often arise:

"Has my PSA increased?"

"Will I need treatment now?"

"Did the MRI show something new?"

"What if the biopsy is worse?"

These feelings are common and should never be dismissed.

Studies have shown that anxiety often decreases over time as patients become more familiar with their surveillance schedule and gain confidence in their healthcare team.

Still, emotional support remains an important part of comprehensive cancer care.

Patients may benefit from:

Seeking emotional support is not a sign of weakness. It is an important part of living well with cancer.


Families Experience Surveillance Too

A prostate cancer diagnosis affects more than the patient.

Partners, spouses, adult children, and close friends often experience uncertainty alongside the person living with cancer.

Family members may wonder:

"Shouldn't the cancer be treated immediately?"

"Are we taking a risk by waiting?"

"What if we miss our opportunity to cure it?"

These concerns are understandable.

Healthcare providers encourage family members to attend appointments whenever possible.

Understanding the evidence behind active surveillance often helps reduce anxiety and allows families to become active partners in shared decision-making.


Emerging Technologies

Researchers continue to improve active surveillance through advances in technology and precision medicine.

Areas of active investigation include:

Genomic Classifiers

Tests such as Decipher®, Oncotype DX®, and Prolaris® analyze the genetic activity of prostate cancer cells to provide additional information about tumor biology.

For selected patients, these tests may help physicians refine risk assessment and personalize surveillance recommendations.


Artificial Intelligence

Artificial intelligence is increasingly being studied to assist radiologists in interpreting prostate MRI.

Although still evolving, AI has the potential to improve consistency, reduce variability, and identify subtle imaging changes that may otherwise be overlooked.


Improved MRI Reporting

Standardized reporting systems, including the PRECISE recommendations, are helping clinicians compare MRI findings over time more consistently.

This may improve confidence when deciding whether surveillance should continue or treatment should be recommended.


Biomarker Research

Researchers are studying new blood, urine, and tissue biomarkers that may improve patient selection and reduce unnecessary biopsies.

Although promising, many of these tools continue to be evaluated before becoming part of routine clinical care.


PCaReview Key Takeaways


Questions to Ask Your Doctor


Shared Decision-Making

Choosing a Path That Reflects Both the Cancer and the Person

Modern prostate cancer care is no longer only about asking:

"What treatment can eliminate the cancer?"

It is also about asking:

"What treatment approach best fits this person—their cancer, their health, their values, and their life?"

This shift represents one of the most important changes in oncology.

Decades ago, treatment decisions were often based primarily on eliminating disease. Today, physicians and patients increasingly recognize that successful cancer care must balance multiple goals:

Active surveillance represents this philosophy in action.

Choosing surveillance requires more than understanding medical facts. It requires a conversation between patient and physician about uncertainty, priorities, expectations, and personal goals.


What Is Shared Decision-Making?

Shared decision-making is a collaborative process where patients and healthcare professionals work together to choose a treatment approach.

It combines:

Medical Evidence

What does research tell us about outcomes, risks, and benefits?

Clinical Expertise

What does the healthcare team know about prostate cancer biology and treatment?

Patient Values

What matters most to the individual patient?

Two patients with very similar prostate cancer characteristics may reasonably choose different paths.

For example:

A 55-year-old man who values preserving sexual function and avoiding treatment side effects may feel comfortable with active surveillance.

Another man with the same cancer characteristics may experience significant anxiety about living with untreated cancer and may prefer definitive treatment.

Neither choice is automatically right or wrong.

The right choice is the one made with accurate information and a clear understanding of the trade-offs.


Understanding the Trade-Offs

Every prostate cancer management strategy involves benefits and risks.

Active Surveillance

Potential Benefits

Potential Challenges


Surgery (Radical Prostatectomy)

Potential Benefits

Potential Challenges

Possible side effects may include:


Radiation Therapy

Potential Benefits

Potential Challenges

Possible side effects may include:


The Importance of a Second Opinion

A prostate cancer diagnosis can feel overwhelming.

Many patients worry that seeking another opinion may offend their physician.

In reality, second opinions are common in cancer care and are often encouraged.

A second opinion may provide:

Important areas where review may be valuable include:

For some patients, simply gaining a clearer understanding of their options provides confidence in their decision.


Becoming Your Own Advocate

Patient advocacy does not mean challenging every medical recommendation.

It means becoming an informed partner in your care.

Effective advocacy includes:

Understanding Your Diagnosis

Ask for copies of:

Learn the language of your cancer:


Asking "Why?"

One of the most powerful questions in medicine is:

"Can you help me understand why you recommend this approach?"

Examples:

Understanding the reasoning behind a recommendation often reduces fear and improves confidence.


Nutrition and Lifestyle Considerations

Supporting Health During Active Surveillance

While nutrition and lifestyle choices do not replace medical treatment, they play an important role in overall health.

A prostate cancer diagnosis often becomes a turning point—a moment when many patients begin focusing more intentionally on their physical and emotional well-being.

The goal is not perfection.

The goal is building sustainable habits that support long-term health.


Eating for Long-Term Health

Research continues to explore the relationship between diet, inflammation, metabolic health, and prostate cancer outcomes.

Although no specific diet has been proven to prevent prostate cancer progression, many experts recommend eating patterns associated with overall health.

A Mediterranean-style eating pattern emphasizes:

It also encourages limiting:

This approach supports cardiovascular health, weight management, and metabolic function—all important considerations for prostate cancer survivors.


Exercise: A Powerful Supportive Therapy

Exercise is one of the most consistently recommended lifestyle interventions for cancer survivors.

Regular physical activity can help improve:

A balanced exercise program may include:

Aerobic Activity

Examples:

Strength Training

Important for:

Flexibility and Balance

Helpful for:

Patients should always discuss exercise plans with their healthcare team, particularly if they have other medical conditions.


Mental and Emotional Wellness

Cancer care is not only about treating disease.

It is also about caring for the person experiencing the disease.

Patients on active surveillance may experience:

Helpful strategies may include:

Many patients find that connecting with others who have experienced prostate cancer reduces isolation and provides valuable perspective.


Myth vs. Fact

Myth:

"Active surveillance means ignoring cancer."

Fact:

Active surveillance is a structured medical program involving regular monitoring, testing, and physician oversight.


Myth:

"Cancer should always be treated immediately."

Fact:

Different cancers behave differently. Some prostate cancers are aggressive, while others grow slowly and may be safely monitored.


Myth:

"If I choose surveillance, I lose my chance for cure."

Fact:

The purpose of surveillance is to identify meaningful changes early enough that treatment can still be effective if needed.


Myth:

"PSA increases always mean my cancer is getting worse."

Fact:

PSA can change for many reasons. Physicians evaluate PSA trends alongside MRI, biopsy findings, and other factors.


Myth:

"Active surveillance is only for older men."

Fact:

Age is only one factor. Overall health, cancer characteristics, life expectancy, and patient preferences all matter.


PCaReview Active Surveillance Decision Checklist

Before choosing active surveillance, consider discussing these questions with your healthcare team.

Understanding My Cancer

☐ What is my Grade Group?

☐ What is my Gleason score?

☐ How much cancer was found in my biopsy?

☐ What does my MRI show?

☐ What is my risk category?


Understanding My Monitoring Plan

☐ How often will I have PSA testing?

☐ When will I have another MRI?

☐ When will another biopsy be performed?

☐ What findings would change my recommendation?

☐ Who should I contact with questions between visits?


Understanding My Options

☐ What are my treatment alternatives?

☐ What are the possible side effects of treatment?

☐ What are the risks of continuing surveillance?

☐ Would a second opinion be helpful?

☐ Are genomic tests appropriate for me?


Understanding Myself

☐ How comfortable am I living with uncertainty?

☐ How important is avoiding treatment side effects?

☐ How will this decision affect my family?

☐ What quality-of-life factors matter most to me?


Glossary

Active Surveillance

A structured program of monitoring prostate cancer with the intention of treating if signs of progression appear.

Watchful Waiting

A less intensive approach focused primarily on managing symptoms rather than detecting progression early.

PSA (Prostate-Specific Antigen)

A protein produced by prostate cells measured through a blood test.

Gleason Score

A grading system describing how prostate cancer cells appear under a microscope.

Grade Group

A modern classification system ranging from Grade Group 1 (least aggressive) to Grade Group 5 (most aggressive).

mpMRI

Multiparametric magnetic resonance imaging used to evaluate prostate abnormalities.

PI-RADS

A standardized MRI scoring system used to estimate the likelihood of clinically significant prostate cancer.

PSA Density

A calculation comparing PSA level with prostate size.

Genomic Classifier

A test analyzing gene activity within prostate cancer tissue to provide additional risk information.


PCaReview Closing Perspective

Active Surveillance Is Not Waiting—It Is Watching With Purpose

The evolution of prostate cancer care has taught medicine an important lesson:

More treatment is not always better treatment.

The goal of modern care is not simply to treat cancer—it is to treat the right cancer, at the right time, for the right person.

Active surveillance represents this philosophy.

For carefully selected patients, surveillance provides an opportunity to maintain quality of life while remaining protected by a carefully designed safety net of monitoring and medical expertise.

Choosing active surveillance does not mean accepting cancer.

It means understanding cancer.

It means recognizing that biology matters.

It means making a thoughtful decision based on evidence, expertise, and personal priorities.

During Prostate Cancer Awareness Month, one message deserves to be repeated:

Knowledge changes decisions.

Informed decisions change outcomes.


References & Resources

National Cancer Institute (NCI)

Active Surveillance for Prostate Cancer

https://www.cancer.gov/types/prostate/active-surveillance

NCI Cancer Currents Blog

Active Surveillance Increasing for Low-Risk Prostate Cancer

https://www.cancer.gov/news-events/cancer-currents-blog/2022/prostate-cancer-active-surveillance-increasing

Johns Hopkins Medicine

Active Surveillance for Prostate Cancer

https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/active-surveillance-for-prostate-cancer

Memorial Sloan Kettering Cancer Center

Active Surveillance Program

https://www.mskcc.org/cancer-care/types/prostate/active-surveillance

Mayo Clinic

Active Surveillance for Prostate Cancer

https://www.mayoclinic.org/tests-procedures/active-surveillance-for-prostate-cancer/about/pac-20384946

National Comprehensive Cancer Network (NCCN)

Clinical Practice Guidelines in Oncology: Prostate Cancer

PubMed / National Library of Medicine

https://pubmed.ncbi.nlm.nih.gov/


Medical Disclaimer

This publication is intended for educational and informational purposes only. It does not replace medical advice, diagnosis, or treatment from a qualified healthcare professional.

Every person's prostate cancer journey is unique. Treatment decisions should always be made in partnership with a healthcare team that understands the individual's cancer characteristics, overall health, and personal goals.

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