Active Surveillance for Low-Risk and Favorable Intermediate-Risk Prostate Cancer
Active surveillance is a structured monitoring strategy for men with low-risk or favorable intermediate-risk prostate cancer that uses serial PSA, multiparametric prostate MRI, and protocolized prostate biopsy to detect meaningful change before initiating treatment. The goal is to avoid the side effects of unnecessary treatment for cancers that are unlikely to threaten quality of life or survival, while preserving the option to treat with curative intent if the cancer behavior changes.
Dr. Wei Phin Tan offers active surveillance for prostate cancer in NYC at NYU Langone Health, Main Campus in Manhattan. Because he also performs HIFU, cryoablation, Aliya PEF, precision robotic prostatectomy, and rectal spacer placement before radiation, surveillance is integrated with every other treatment option, not isolated from them.
"Not every prostate cancer needs aggressive treatment. For the right patient, active surveillance is the most evidence-based way to avoid unnecessary side effects, without giving up the option of cure if the cancer behavior changes."- Dr. Wei Phin Tan, MD, MHS, FACS
Who Is a Candidate for Active Surveillance?
Candidacy is individualized and based on the full clinical picture. In general, candidates include:
- Low-risk prostate cancer: Gleason 6 / Grade Group 1, low PSA density, limited core involvement on biopsy
- Selected favorable intermediate-risk prostate cancer: low-volume Gleason 3+4 / Grade Group 2 with reassuring MRI and stable PSA
- MRI findings that correlate with the biopsy and do not suggest hidden higher-grade disease
- Stable PSA kinetics over time
- Absence of high-risk germline mutations or strong family history that would change risk calculus
- Patient preference for avoiding the early side effects of treatment
Who Is Not a Good Candidate?
- Gleason 4+3 (Grade Group 3) or higher
- High-volume Gleason 3+4 disease, especially with cribriform or intraductal pattern
- MRI lesion that is discordant with biopsy and suggests undersampling of higher-grade disease
- Persistently rising PSA kinetics
- Selected men with strong family history or high-risk germline mutations (for example, BRCA2)
Dr. Tan's Active Surveillance Protocol
Surveillance is not a single test repeated forever. It is a structured program designed to detect meaningful change early.
- PSA every 3 to 6 months with attention to PSA density and kinetics
- Digital rectal examination at each office visit
- Multiparametric prostate MRI on a periodic schedule, typically annually or per protocol, to assess for new or growing lesions
- Confirmatory transperineal MRI/ultrasound fusion biopsy at approximately 1 to 2 years from initial diagnosis. Transperineal biopsy is performed in the office under local anesthesia, with markedly lower infection risk than traditional transrectal biopsy and improved sampling of the anterior prostate
- Protocolized follow-up biopsies based on PSA kinetics, MRI stability, and time since last biopsy
- Genetic and germline testing when family history or pathology suggests it should change management
Active Surveillance vs Watchful Waiting
Active surveillance is often confused with watchful waiting. They are not the same.
| Active Surveillance | Watchful Waiting | |
|---|---|---|
| Goal | Defer treatment safely while preserving cure | Manage symptoms when they arise |
| Monitoring intensity | High (PSA, MRI, biopsies) | Lower |
| Curative treatment available | Yes, if disease progresses | Generally no |
| Typical patient | Otherwise healthy with low-risk or favorable intermediate-risk disease | Limited life expectancy or high comorbidity |
This comparison is general. Individual decisions depend on age, life expectancy, risk profile, and patient values.
When Surveillance Should Transition to Treatment
Treatment is generally considered when one or more of the following develops:
- Grade progression on biopsy (for example, new or increasing Gleason 4 disease)
- Rising tumor volume on biopsy or MRI
- New or growing MRI-visible lesion
- Persistently rising PSA kinetics that are not explained by infection, instrumentation, or BPH
- Patient preference for definitive treatment
Because Dr. Tan offers the full spectrum, the transition from surveillance to focal therapy, robotic prostatectomy, or radiation preparation can be planned and coordinated by the same physician.
FAQ
What is active surveillance for prostate cancer?
Is active surveillance safe?
Can I switch from active surveillance to focal therapy or surgery later?
How often will I need a biopsy?
What is the difference between Gleason 6 and Gleason 3+4 on surveillance?
Does Dr. Tan recommend surveillance or treatment first?
Selected Evidence (Dr. Tan's Published Work)
Dr. Tan is a contributing author on the international Delphi consensus on transitioning from active surveillance to focal therapy, and on related prostate cancer surveillance and imaging work:
- Tan WP, Rastinehad AR, Klotz L, et al. Focal therapy for patients discontinuing active surveillance, Delphi consensus. Urologic Oncology. 2021. PMID 33676851
- Tan WP, Mazzone A, Shors S, et al. Central zone lesions on MRI: clinical significance. Urologic Oncology. 2017. PMID 27692837
- Tan WP, Wysock JS, Lepor H. Partial gland cryoablation for prostate cancer, where are we? Nature Reviews Urology. 2023. PMID 36434111
Full publication list pulled live from PubMed on the Publications page.