Active surveillance not only reduces morbidity, It saves lives.

The concept of active surveillance is based on the observation that Gleason 6 (pattern 3) prostate cancer is an indolent condition that poses little or no threat to the patient’s life. This view is supported by the molecular characteristics and clinical behavior of the disease. Conservative management is thus appropriate for these patients. Close and ongoing monitoring is required for two reasons: (1) to identify those patients initially diagnosed with Gleason 6 disease who harbor higher-grade cancer, and (2) to find the small proportion of patients who have true biological progression over time. Despite these two concerns, the majority of patients will remain unaffected and untreated, thereby avoiding the significant quality-of-life effects of radical intervention for prostate cancer. Those patients who are eventually reclassified as higher risk and who are subsequently treated have an extremely small likelihood of dying of prostate cancer.