For Early Prostate Cancer ‘Active Surveillance’ Is Now #1 Choice

Three decades after UC San Francisco pioneered “active surveillance” for patients with low-risk prostate cancer, a new study has found that the vast majority of veterans with the diagnosis pursued this option instead of treatment.

In 2024, 93% of veterans with low-risk prostate cancer — so called for its small size and nonaggressive cell type — underwent active surveillance, or monitoring of their tumors with regular tests but no treatment, compared to 27% in 2005, according to a new study published in Aug. 13. At the same time, among veterans with favorable intermediate risk prostate cancer, the rate rose to 61% in 2024 from 14% in 2005.

For the study, researchers from UCSF and the San Francisco VA Health Care System followed more than 73,000 veterans enrolled in the VA system.

Active surveillance includes blood tests every three to six months for prostate-specific antigen (PSA) — a protein produced by prostate tissue — together with less frequent rectal exams, MRIs, and biopsies. If the cancer is found to have grown, surgery or radiation is considered.

UCSF played a foundational role in making active surveillance the national standard of care for low-risk prostate cancer. Studies have shown similar survival outcomes for surveillance compared to treatment, with lower risks of urinary incontinence, bowel problems, or erectile dysfunction.

“Prostate cancer screening saves thousands of lives by finding aggressive cancers early, but it also detects many slow-growing cancers that do not spread, and should not be treated except in rare situations,” said senior author Matthew Cooperberg, MD, MPH, Helen Diller Family Chair of the UCSF Department of Urology.