Active Surveillance for Prostate Cancer
Updated on October 9, 2025
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Prostate cancer is the most common solid malignancy among men in the United States. According to the American Cancer Society, an estimated 313,780 men nationwide will be diagnosed with the disease in 2025. Prostate cancer comes in all kinds of varieties, from serious and life-threatening cases all the way to the more common, nonaggressive forms that are typically age related. The disease tends to occur in men as they age, so the presence of coexisting diseases can play a role in choosing treatment options.
What Is Active Surveillance?
After diagnosis, if eligible, you might consider an active surveillance approach instead of seeking treatment right away. What does this mean? You would basically meet regularly with your doctor and go through periodic testing to monitor your prostate and make sure there is no meaningful change in your cancer.
This would include a prostate-specific antigen (PSA) test about every six months and a digital rectal exam (DRE) at least once a year. Your doctor is also likely to obtain either an MRI of the prostate or a repeat biopsy of the prostate at no more often than yearly intervals.
If there are changes in your results, your doctor might recommend taking a different approach and discuss other treatment methods, including surgery and radiation.
When Might Active Surveillance Be the Best Option?
Active surveillance for prostate cancer is appropriate in patients with lower-risk prostate cancers that show no evidence of having spread outside the prostate. Patients with high-risk prostate cancers would not be eligible for this approach.
Observation of cancer as a concept seems confusing at first, but if you are diagnosed with low-risk cancer, based on findings from your biopsy, active surveillance avoids any side effects associated with cancer treatments like surgery or hormone therapy. Monitoring the cancer hasn’t been shown to result in an unacceptable likelihood of the disease progressing.
In people with other serious illnesses or of advanced age, active surveillance may help avoid difficult decisions relating to life expectancy. For example, an elderly gentleman with a lot of other conditions who is diagnosed with low-risk prostate cancer may not need to worry about treating it. It’s a tough conversation to have, but in these cases, other illnesses may be more severe and life-threatening, so treatment for that low-risk prostate cancer may not be needed.
Understandably, this is a difficult concept to accept. That being said, it’s important to have honest discussions with your family and your doctors about this treatment path.
Is Active Surveillance Safe?
Recent studies suggest we are correct to offer this approach to patients with low- or intermediate-risk prostate cancer. One study in JAMA Network Open speaks to the increasing acceptance of this treatment approach every year in the United States. Another study talks about safety with this approach in terms of cancer progression, which occurs only at extremely low rates.
Prostate Cancer Disparities
In the United States, prostate cancer disproportionally affects Black American men, who are both more likely to be diagnosed with prostate cancer and to die of the disease.
Why the cancer rate is so much higher among Black American men is complex and includes both social and environmental factors — but the reason could also partially be based on tumor biology. Active surveillance is an option for Black American patients, but their disease might be more aggressive; as a result, surgery or radiation might be discussed as an option sooner.
Many men are diagnosed with prostate cancer that can safely be watched, while many other men are diagnosed with aggressive prostate cancer that is dangerous to them. How do we navigate those two problems at the same time? It will take more study, research, and education of patients.
Learn more about active surveillance for prostate cancer from NewYork-Presbyterian Health Matters.
The Takeaway
- Active surveillance is a viable option for men diagnosed with low-risk prostate cancer, enabling them to avoid the side effects of traditional treatments like surgery and hormone therapy.
- Active surveillance involves regular monitoring through PSA tests and exams, and adjusting treatment if significant changes are found.
- While studies suggest active surveillance is safe for many with low- to intermediate-risk prostate cancers, it is less appropriate for those with high-risk cancers due to the potential for rapid progression.
- Disparities in prostate cancer outcomes, particularly among Black American men, highlight the importance of personalized care and the need for ongoing research and discussion about treatment options.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Key Statistics for Prostate Cancer. American Cancer Society. May 30, 2025.
- Active Surveillance for Prostate Cancer. Mayo Clinic. November 15, 2023.
- Active Surveillance for Prostate Cancer. Johns Hopkins Medicine.
- Daskivich TJ et al. Overtreatment of Prostate Cancer Among Men With Limited Longevity in the Active Surveillance Era. JAMA Internal Medicine. November 11, 2024.
- Ventimiglia E et al. Long-term Outcomes Among Men Undergoing Active Surveillance for Prostate Cancer in Sweden. JAMA Network Open. September 1, 2022.
- Bangma C et al. Has Active Surveillance for Prostate Cancer Become Safer? Lessons Learned from a Global Clinical Registry. European Urology Oncology. April 2025.
- Why Black Men Should Consider Earlier Screening for Prostate Cancer. Memorial Sloan Kettering Cancer Center. January 17, 2025.
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Daniel Landau, MD
Medical Reviewer
Daniel Landau, MD, is a distinguished board-certified hematologist-oncologist with a career that has spanned two eminent institutions: the Orlando Health Cancer Institute and the M...
Joseph Alukal, MD
Author
From NewYork-Presbyterian
Joseph Alukal, MD, is the director of men's health at NewYork-Presbyterian and Columbia University Irving Medical Center and fellowship director in andrology–male reproductive heal...