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Doctors at NYU Langone’s Perlmutter Cancer Center may recommend active surveillance for men who meet one or more of the following criteria:

• The cancer is confined to the prostate; this can be confirmed through imaging tests such as bone scans, ultrasounds, CT scans, MRIs, or PET scans.
• The tumor is small and slow growing: this is often indicated by PSA less than 10 and a low Gleason score of 6, which is considered the least aggressive. A Gleason score is a grading system specific to prostate cancer.
• No symptoms. Common symptoms include urinary discomfort or incontinence, bone pain, unexplained weight loss, and erectile dysfunction.
• The cancer does not impact quality of life. We consider the patient’s overall wellbeing and whether he is experiencing any physical, functional, mental, or social impact.
• A low risk of the cancer spreading. Doctors examine biopsied cells to determine the risk of metastasis. The most common approach is Gleason scoring, but some patients may benefit from genomic testing (such as the Decipher test), which can identify potential gene mutations that indicate a high risk for spreading.
• The tumor is not life-threatening. A prostate tumor is considered life-threatening when it has spread beyond the prostate and into other parts of the body.
• Life expectancy is limited by other health conditions or age. Prostate cancer treatment often has many side effects and can make existing health conditions worse for some patients. Active surveillance may be recommended to avoid additional risks or complications.

Our doctors provide extensive guidance to ensure you feel comfortable with a treatment plan. They can help determine whether active surveillance is appropriate and develop a personalized care plan with you.

During active surveillance, regular tests are done to monitor the tumor. They include the following:

• Prostate-specific antigen (PSA) blood tests, which are typically done every six months. If there has been a significant increase in PSA levels between tests, patients may be asked to repeat testing six to eight weeks later. High levels of PSA may be an indication of prostate cancer.
• Digital rectal exams, in which a doctor carefully inserts a gloved, lubricated finger into the rectum. The doctor feels the edges of the prostate gland for abnormalities, such as tenderness, lumps, or hard spots.
• Imaging tests, such as an ultrasound or MRI, let doctors view the entire prostate to detect major changes in the tumor’s type, size, and location. Our doctors typically recommend an MRI every 18 months during active surveillance. If MRI results are unusual, doctors may recommend a prostate biopsy.
• Prostate biopsies, during which doctors take a small sample of tissue from the prostate gland and test it for cancerous cells. They assign the sample a Gleason score

from 6 to 10. In some cases, doctors may use a fusion biopsy, which combines MRI and ultrasound imaging to create a detailed, real-time 3D image of the prostate. This advanced approach allows doctors to more precisely target areas for sampling. During active surveillance, patients typically get a prostate biopsy once every three years.

Active surveillance may last a few years, and patients whose conditions do not change may remain on active surveillance indefinitely. If there is evidence that the cancer is progressing, our doctors may recommend surgery, radiation therapy, or focal ablation.