Doctors Recommend Active Surveillance for Low-Risk Prostate Cancer
For men with early, slow-growing prostate cancer, doctors advise active surveillance—regular monitoring instead of immediate treatment—to avoid unnecessary side effects while still managing the disease.
Prostate cancer, the most common cancer among U.S. men, is often detected through elevated PSA levels followed by imaging and biopsy. For patients whose disease is classified as low-risk—about 14% of new diagnoses—medical experts suggest active surveillance rather than immediate surgery or radiation. The approach involves routine check-ups, PSA tests every six months, annual rectal exams and periodic imaging or biopsies, allowing doctors to intervene promptly if the tumor shows signs of growth.
"Gleason grade 1, or the earliest stage, those patients are not immediately at risk of having progression of their cancer," said Dr. William Dahut, chief scientific officer for the American Cancer Society.
"Sometimes we see it changing relatively quickly, but almost always we have time to intervene prior to symptoms or putting patients at any real risk," he added.
Active surveillance differs from watchful waiting, which relies on symptom monitoring and is typically reserved for older patients or those with serious comorbidities. The goal of early treatment is to prevent cancer-related complications, but surgery, radiation and other therapies can cause urinary, bowel and sexual side effects. By delaying treatment when appropriate, patients can preserve quality of life while retaining the option to start therapy if needed.
"If the patient has no symptoms, any therapy would make them feel much worse," Dahut explained.
The American Cancer Society recommends average-risk men begin PSA screening at age 50, with earlier testing for higher-risk individuals. Men diagnosed with low-risk disease are encouraged to discuss active surveillance options with their physicians.