Active surveillance was originally developed for men with lower-risk prostate cancer.
This typically included:
- Gleason score of 6
- PSA below 10
- Limited cancer involvement on biopsy (for example, three or fewer positive cores, with less than 50% involvement in any one core)
Some men with Gleason 7 (3+4, but not 4+3) disease may also be considered for active surveillance in select cases. However, the original criteria were more restrictive and focused on Gleason 6.
Active surveillance allows some men with low-risk prostate cancer to delay treatment while the disease is monitored. For the right patient, it can be a safe and effective strategy.
But surveillance is not always permanent.
What Active Surveillance Involves
Active surveillance typically includes:
- regular PSA testing
- periodic prostate MRI
- repeat biopsies over time
The goal is to monitor the cancer closely and intervene only if there are signs of progression.
When Reassessment Becomes Important
Over time, certain changes may indicate that continued surveillance is no longer the best option.
These include:
Prostate Cancer Treatment Options
- rising PSA levels
- MRI showing lesion growth or new areas of concern
- increase in tumor volume
- higher Gleason score on repeat biopsy
- changes in patient comfort with ongoing monitoring
These findings do not automatically require aggressive treatment, but they do signal that the situation should be reassessed.
The Role of Repeat Imaging and Biopsy
MRI and confirmatory biopsy are central to this decision-making process.
They help determine whether the cancer remains stable or is evolving.
This information allows patients and physicians to decide whether:
- surveillance can safely continue
- focal therapy may now be appropriate
- or another treatment approach should be considered
A Planned Transition, Not a Failure
Moving from surveillance to treatment is not a failure.
It reflects a planned and responsive approach to managing low-grade to intermediate prostate cancer over time.
For some men, focal therapy offers an option to treat cancer while preserving as much normal tissue as possible.
Recognizing When Treatment is the Next Step
Deciding when to move from surveillance to treatment is one of the most important decisions in prostate cancer care.
It should be based on clear imaging, accurate biopsy data, and individual priorities.
Book a consultation with Urology Innovations Canada to review whether active surveillance remains the right approach in your case.