What does active surveillance mean for a patient with low‑risk prostate cancer (Gleason score 3+3, 3 of 12 biopsy cores positive with <5%, <5% and 7% involvement)?

Active Surveillance for Low-Risk Prostate Cancer

Active surveillance is a structured monitoring program that avoids immediate treatment for low-risk prostate cancer, allowing you to defer surgery or radiation while closely tracking the cancer with regular PSA tests, physical exams, and repeat biopsies to detect any progression that would warrant intervention. 1

Why Active Surveillance is Appropriate for Your Case

Your biopsy results demonstrate very low-risk prostate cancer that meets all criteria for active surveillance 1:

• Gleason score 3+3=6 (ISUP Grade 1) - the lowest grade of prostate cancer 1
• Only 3 of 12 cores positive (25% positive cores, well below the 50% threshold) 2, 1
• Minimal tumor involvement (<5%, <5%, and 7% per core - all well below 50% per core) 2, 1

This cancer poses minimal threat to your life. Studies show prostate cancer-specific mortality is less than 1% at 15 years for patients like you on active surveillance 1. Patient survival reaches 99.2% at 8 years and 100% at 10 years in major surveillance cohorts 2.

What Active Surveillance Involves

Initial Confirmatory Steps

• Confirmatory biopsy within 6-24 months to ensure no higher-grade cancer was missed on initial sampling 1
• Consider multiparametric MRI if not already performed to better characterize disease extent 1

Ongoing Monitoring Protocol

PSA Testing:

• Every 3-6 months for the first 2 years 2, 1
• Every 6 months thereafter if PSA remains stable 2, 1

Physical Examination:

• Digital rectal exam every 6-12 months 1

Repeat Biopsies:

• At 1 year after diagnosis 2, 1
• Every 3 years for the first 10 years 2, 1
• Triggered earlier if PSA rises significantly or exam changes 2, 1

When Treatment Becomes Necessary

You would transition from surveillance to treatment if: 2, 1

• PSA doubling time less than 3 years (requires at least 8 PSA measurements) 2
• Upgrade to Gleason score 3+4=7 or higher on repeat biopsy 2, 1
• More than 3 positive cores or >50% involvement per core on repeat biopsy 2
• MRI progression showing new or enlarging lesions 1

Approximately 20-30% of patients eventually proceed to treatment, typically within the first few years of surveillance 2, 1.

Key Advantages of This Approach

Active surveillance avoids treatment-related complications while maintaining excellent cancer control 2:

• Preserves quality of life by avoiding immediate surgery or radiation side effects 2
• Prevents overtreatment of cancer unlikely to cause harm 3, 4
• Allows curative treatment later if cancer progresses, without compromising outcomes 2, 5
• Surgery after surveillance remains effective - patients who eventually need treatment have outcomes equivalent to those treated immediately 5

Treatment side effects you're avoiding include urinary incontinence (6 times more common after surgery than radiation) and erectile dysfunction (affecting approximately 75% of treated patients) 2.

Critical Considerations

This approach requires commitment: 2, 1

• You must adhere to the monitoring schedule consistently
• You must accept that PSA may rise and the tumor may grow over time
• You need psychological comfort with "watching" cancer rather than immediately treating it

However, anxiety levels among surveillance patients are generally favorable 2, and over 90% of patients report satisfaction with their decision 2.

The 30% risk of finding higher-grade cancer on confirmatory biopsy is why that repeat biopsy within the first 1-2 years is essential 3, 4. This doesn't represent progression but rather sampling error on the initial biopsy.

What Makes Your Case Ideal for Surveillance

Your specific findings are particularly favorable 1, 6:

• Very low percentage of core involvement (all cores <10%)
• Low number of positive cores (3 of 12 = 25%)
• Pure Gleason 3+3 pattern with no pattern 4 or 5 disease

These parameters place you in the lowest risk category where active surveillance is not just acceptable but the preferred standard of care according to major guidelines 1.