Active Surveillance for Prostate Cancer

A Proven Strategy for Managing Low-Risk Prostate Cancer

At Urology Partners of North Texas (UPNT), research has shown that certain prostate cancers—particularly low-risk cancers—do not require immediate treatment. Instead, Active Surveillance is often the best option, allowing men to avoid unnecessary procedures while carefully monitoring the cancer over time.

Our team of expert urologists uses a combination of advanced imaging, genetic testing, and regular follow-ups to ensure that your cancer remains under control and that treatment is initiated only if necessary.

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Why Choose Active Surveillance?

Some prostate cancers grow so slowly that they may never cause serious health problems. For many men, especially those with Gleason 6 prostate cancer, immediate treatment isn’t necessary. Studies involving over 20,000 men with Gleason 6 cancer found no cases of distant metastasis beyond the local pelvic area.

Here’s why Active Surveillance is essential:

Biopsies only sample part of the prostate, meaning more aggressive cancer could still be present.
Low-volume Gleason 7 cancers (3+4) may still qualify for Active Surveillance if molecular testing confirms low risk.
The goal is to intervene early if cancer progresses while preserving quality of life.

At UPNT, our urologists use:

Expert Pathology Review – Ensuring an accurate Gleason score.
Molecular Testing – Identifying the genetic behavior of your cancer.
Multiparametric MRI (mpMRI) – High-resolution imaging to monitor changes.
Regular PSA Testing & Physical Exams – Tracking prostate health every 6 months to 1 year.

Understanding Gleason Scores

The Gleason score is used to determine how aggressive prostate cancer is under a microscope. This score helps decide if active surveillance is a safe and effective option.

Gleason Score

Meaning

Risk of Spreading?

Recommended Approach

Gleason 6

Slow-growing, confined to prostate

Rare, stays in local area

Active Surveillance

Gleason 7 (3+4, Low Volume)

Mostly Gleason 3, small Gleason 4

Low but not zero

Possible Active Surveillance if molecular tests confirm low risk

Gleason 7 (4+3 or High Volume 3+4)

Mostly Gleason 4, more aggressive

Moderate risk

Treatment recommended

Gleason 8–10

High-risk, aggressive cancer

High risk of spreading

Immediate treatment

💡 Key Point: While most men with Gleason 7 need treatment, some low-volume 3+4 cases may qualify for Active Surveillance—but only if molecular testing and MRI confirm low-risk disease.

How Molecular Testing Helps Determine Low-Risk Cancer

Since biopsies sample only part of the prostate, genetic testing provides an essential second layer of information to confirm if cancer is truly low-risk.

Molecular Marker

What It Measures

Why It Matters

Oncotype DX Genomic Prostate Score

Gene activity linked to tumor aggressiveness

Predicts if Active Surveillance is a safe option

Decipher Prostate Test

Genetic mutations in cancer cells

Helps decide if monitoring or treatment is best

Prolaris Test

Cell division speed in tumor tissue

Estimates how quickly cancer may progress

💡 For men with low-volume Gleason 7 (3+4), molecular markers can confirm whether Active Surveillance is a safe option.

Multiparametric MRI: A Critical Tool for Active Surveillance

Multiparametric MRI (mpMRI) is a vital imaging tool that provides a detailed view of the prostate and monitors cancer progression over time.

How Does Active Surveillance Work?

Active Surveillance is a structured monitoring plan that reduces the risk of overtreatment while ensuring cancer is closely watched.

Here’s what the typical plan looks like:

When Does Active Surveillance Switch to Treatment?

Active Surveillance is designed to catch changes early. If any of the following occur, treatment may be recommended:

💡 The goal is to intervene early if cancer shows signs of progression—before it becomes metastatic.

Why Choose UPNT for Active Surveillance?

We combine advanced pathology, molecular testing, and imaging to create personalized monitoring plans.

Our team has extensive experience managing prostate cancer with Active Surveillance.

Access to the latest MRI technology and genomic testing.

We prioritize quality of life and long-term health, ensuring every patient receives individualized care.

Frequently Asked Questions (FAQs)

Do Gleason 6 cancers ever spread?

No. Gleason 6 prostate cancer rarely, if ever, spreads beyond the local area (prostate and pelvic region). Studies of over 20,000 men found no cases of distant metastasis.

Can some Gleason 7 cancers qualify for Active Surveillance?

some low-volume Gleason 7 (3+4) cases may still qualify if genetic testing and MRI confirm low risk. However, higher-volume 3+4 and 4+3 cases usually require treatment.

Why treat prostate cancer before it becomes metastatic?

Once prostate cancer spreads beyond the prostate, it is much harder to treat and may no longer be curable. Catching it early is essential.

If I have Gleason 6 prostate cancer, do I need to treat it right away?

Not always. Gleason 6 is considered low-risk and often grows slowly, which is why many men choose active surveillance—a safe, monitored approach using regular PSA testing, MRI scans, and occasional biopsies.

That said, 30–45% of men initially diagnosed with Gleason 6 prostate cancer are later found to have Gleason 7 or higher within the first 10 years. This is why close monitoring is critical: if the cancer becomes more aggressive, treatment can start right away.

Schedule a Consultation to See if Active Surveillance is Right for You

📅 Not all prostate cancers need immediate treatment—find out if Active Surveillance is right for you.