Active surveillance for early prostate cancer

Just diagnosed

You’ve just been told you have prostate cancer. Your doctor says it’s early or low risk. For many men, that means you may not need surgery or radiation right away. I’m Dr. Jason Lomboy with Advanced Urology. Let’s talk about active surveillance—watching the cancer closely and treating it if it changes.

Grade and volume

Two things matter most right now: your grade and how much cancer there is.

Your grade comes from the biopsy. Gleason 6, or Grade Group 1, is low risk. It generally grows slowly and rarely spreads. Gleason 7 is intermediate risk. It’s a bit more active, but still often found early.

Volume is how much cancer is there. We look at your MRI and your biopsy—how many samples contain cancer and how much of each sample is tumor. A little cancer in one or two spots is very different from cancer in many spots. Your grade, your volume, and your PSA help guide the plan.

Genomic testing

At Advanced Urology, we also use genomic testing on the biopsy. These tests look at gene activity in the cancer cells and give us extra information about how aggressive it is. That helps us decide whether surveillance is appropriate or whether treating it sooner makes more sense for you.

What surveillance involves

Active surveillance is not ignoring the cancer. It’s a structured plan. You’ll have a PSA blood test about every six months, a prostate MRI at regular intervals, and repeat biopsies as needed.

We do this with modern imaging and targeted biopsy. Our biopsies are transperineal MRI fusion biopsies. We combine your MRI with live ultrasound to create a 3D map so we can target suspicious areas precisely. The needle goes through the skin behind the scrotum instead of through the rectum, which lowers infection risk.

At Advanced Urology, we perform these biopsies under anesthesia in our own accredited surgery centers. You’re asleep during the procedure, with anesthesia to control pain. Some soreness or discomfort can occur afterward.

Who it may help

For most men with Gleason 6, active surveillance is the recommended first choice. It’s also an option for some men with a small amount of Gleason 3+4, also known as Grade Group 2.

Benefits and trade-offs

The biggest benefit is avoiding or delaying treatment and its potential side effects, including changes in erections and bladder control. Surveillance itself still involves tests and biopsies, which carry risks.

Long-term research supports active surveillance for appropriately selected men with low-risk prostate cancer. Regular monitoring helps us identify changes that may mean it’s time for treatment.

Some men on surveillance eventually need treatment, usually because a later biopsy shows the cancer has changed. That isn’t a failure. You can still consider surgery or radiation later if you need them.

Another potential benefit is that treatment options continue to evolve. Vanquish is a newer focal therapy designed to treat targeted prostate cancer while limiting side effects, though side effects can still occur. Insurance coverage may not be available, so costs need to be confirmed. Surveillance is appropriate when the cancer’s risk allows it—not simply to wait for a new treatment.

Living with surveillance

Surveillance does mean regular tests and biopsies, and some men feel anxious knowing the cancer is still there. That’s normal, and we talk through it.

If you have a small volume of Gleason 6 and you’re comfortable with checkups, active surveillance may help you avoid or delay treatment. Your grade, your volume, your MRI, your genomic testing, and what matters most to you shape the choice.

Call Advanced Urology at 678-344-8900. Our urologists can usually see you quickly and help you decide what fits. This article is educational, not medical advice.