I spent 35 years as a GP. I have read the NCI data on Gleason 6 progression. The surveillance opt…
T=0: The Decision
Diagnosed with low-grade prostate cancer (Gleason 6, PSA 4.8) at 62. The urologist offered three options: radical prostatectomy, radiotherapy, or active surveillance. The surgical and radiotherapy options carried meaningful risks of incontinence and erectile dysfunction. Active surveillance meant monitoring without immediate treatment and accepting a small risk of progression.
I spent 35 years as a GP. I have read the NCI data on Gleason 6 progression. The surveillance option is evidence-based for low-grade, low-volume tumours and is exactly what I would have recommended to a patient in my position. The difference is recommending it to yourself.
Unchanged PSA at 24 months. Quality of life preserved.
6 Months Out
PSA at 6 months: 4.6 (stable). MRI clear. The anxiety of monitoring is real in a way that treating the disease removes — there is a cognitive cost to choosing watchful waiting that the literature understates. I am managing it by focusing on what the data actually says rather than what the fear suggests.
“Active surveillance requires strict protocol adherence — PSA every 3–6 months, annual MRI, periodic biopsies. The monitoring burden is the trade you make. If you will not adhere to it, the option is less appropriate.”