Receiving a prostate cancer diagnosis is a life-altering moment. For many men, the immediate instinct is to “get it out” as quickly as possible. However, modern urology has shifted significantly toward a strategy called Active Surveillance.
In 2026, Active Surveillance is now the preferred management for the majority of low-risk prostate cancers in Australia. Here is why choosing not to operate immediately is often the safest and most effective way to protect your long-term health.
What is Active Surveillance?
It is a common misconception that Active Surveillance means “doing nothing.” In reality, it is a proactive, highly structured program of monitoring. Unlike “Watchful Waiting” – which is typically reserved for much older men with other health issues – Active Surveillance is a curative-intent strategy.
The goal is to avoid or delay invasive treatments (like surgery or radiation) and their potential side effects, such as urinary incontinence or erectile dysfunction, for as long as it is safe to do so.
How it Works:
- Regular PSA Testing: Typically every 3 to 6 months to monitor for any spikes.
- mpMRI Scans: Advanced imaging to visualize the prostate and ensure the tumor remains localized.
- Periodic Biopsies: To confirm the “grade” of the cancer hasn’t changed.
Am I a Candidate? (The 2026 Criteria)
Urologists use specific clinical benchmarks to determine if a patient is suitable for surveillance. Generally, you may be a candidate if:
- Gleason Score is 6 (Grade Group 1): This indicates the cells look similar to healthy cells and are very slow-growing.
- PSA Level is Low: Typically under 10 ng/mL.
- Tumor is Small: The cancer is confined to a small area within the prostate and is not felt during a physical exam (T1–T2a stage).
In some cases, men with “favorable” intermediate-risk cancer (Gleason 7) may also be eligible for surveillance, depending on their age and overall health.
Why “Waiting” is Often Better for Your Quality of Life
The primary benefit of Active Surveillance is the preservation of your daily lifestyle. Radical treatments can carry a high “functional cost.”
Recent research presented at the 2026 European Association of Urology Congress confirmed that men on Active Surveillance report a quality of life nearly identical to men without cancer. By avoiding immediate surgery, you maintain:
- Full Urinary Control: Avoiding the risk of post-operative leakage.
- Sexual Function: Preserving the nerves responsible for erections.
- Peace of Mind: Knowing that if the cancer ever does show signs of becoming aggressive, we can switch to active treatment (like robotic surgery) immediately with no loss of curative potential.
Dealing with “Cancer Anxiety”
It is natural to feel anxious about “living with cancer.” However, it is important to remember that most low-risk prostate cancers grow so slowly that they may never cause symptoms or become life-threatening.
Choosing Active Surveillance is not about ignoring the problem; it is about choosing the right treatment at the right time. For many Australian men, that time may be years away – or it may never come at all.
Contact Us
Dr. Arianayagam is an expert in urological cancer surgery and the treatment of urological conditions. He is one of the most experienced cancer surgeons in Sydney.
After training in NSW, further training in Urologic Oncology was undertaken at the University of Miami Miller School of Medicine. He completed a two-year fellowship accredited by the Society of Urologic Oncology.
If you have any further questions about urological health or would like to book an appointment, please feel free to call.
