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Updated: May 12, 2026

A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance

A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance

Published on: November 7, 2025

Active surveillance: patient selection.

Laurence Klotz¹

¹Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Laurence.klotz@sunnybrook.ca

Current Opinion in Urology

|April 4, 2013

Summary

Active surveillance is a safe approach for many men with low-risk prostate cancer, reducing overtreatment. Eligibility considers cancer grade, volume, PSA density, age, and patient preferences.

Area of Science:

Oncology
Urology

Background:

Gleason 6 prostate cancer is often indolent, with Gleason pattern 3 lacking malignant molecular characteristics.
A subset of patients may have undetected aggressive disease or progress to higher grades over time.

Purpose of the Study:

To summarize patient selection for active surveillance in prostate cancer.
To review eligibility criteria, current controversies, and the role of imaging in active surveillance.

Main Methods:

Active surveillance involves expectant management for favorable-risk disease.
Serial prostate-specific antigen (PSA) testing and biopsies are key components.
Eligibility assessment includes Gleason score, cancer volume, PSA density, Epstein criteria, and patient factors.

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Main Results:

Most patients with Gleason 6 prostate cancer are candidates for active surveillance.
Very low-risk patients meet Epstein criteria (e.g., PSA density < 0.15).
Patients with Gleason 7 (less than 10% Gleason 4) may also be eligible.

Conclusions:

Active surveillance effectively reduces overtreatment of screen-detected prostate cancer.
Approximately 50% of newly diagnosed patients are eligible.
Patient age, comorbidities, cancer risk, and preferences are crucial for decision-making.