Related Experiment Video
Updated: Feb 18, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
Patient-reported outcomes: active surveillance vs radical therapies in low-risk prostate cancer
Mulham Al-Nader1, Claudia Kesch1, Osama Mahmoud1
1Department of Urology, University Hospital Essen, Essen, Germany.
Objective:
To prospectively evaluate functional patient-reported outcomes (PROs) in patients with low-risk prostate cancer (PCa) managed with active surveillance (AS), nerve-sparing radical prostatectomy (NS-RP), non-NS-RP, or radiotherapy (RT).
Patients And Methods:
This multicentre prospective cohort study used data from the Prostate Cancer Outcomes (PCO) study in Germany, Austria and Switzerland, including 6265 patients with low-risk PCa enrolled between 2016 and 2023. PROs were assessed at baseline and 12 months after treatment/enrolment using the 26-item Expanded Prostate Cancer Index Composite Short Form (EPIC-26), measuring urinary continence, bowel, sexual, hormonal, and irritative/obstructive symptoms. Mean score changes were compared with minimal important differences (MIDs) to determine clinical significance.
Results:
In all, 475, 4352, 813, and 625 patients received AS, NS-RP, non-NS-RP, and RT, respectively. At 12 months, AS was associated with stable function across all EPIC-26 domains. In contrast, both RP groups experienced significant declines in urinary continence (NS-RP: -18 points; non-NS-RP: -26 points) and sexual function (NS-RP: -35 points; non-NS-RP: -30 points), exceeding MID thresholds. Urinary continence did not decline after RT but clinically relevant declines occurred in irritative/obstructive urinary (-5 points), bowel (-7 points), hormonal (-5 points), and sexual function (-12 points). Age-stratified analysis showed clinically significant declines in urinary and sexual function after NS-RP across all age groups, with the greatest loss in sexual function among younger patients and the most pronounced continence impairment in the 70-79 years age group. In contrast, functional outcomes under AS remained stable in all age cohorts.
Conclusion:
Active surveillance is underutilised in the observed cohort. Prospective PCO data demonstrates that AS preserves urinary continence and sexual function compared to active treatment, supporting its role as the first-line strategy for suitable candidates. Despite advancements including NS techniques, RP, and to a lesser extent RT, remain associated with substantial functional impairment even in younger men.
