Prostate cancer
ICD-10 C61 · ICD-11 2C82

What to Do When Active Surveillance Has Failed in Low-Risk Localised Prostate Cancer (ISUP GG1, PSA <10 ng/mL)

This protocol applies to male patients with low-risk localised prostate cancer — ISUP grade group 1, PSA <10 ng/mL, clinical stage cT1–2a — and a life expectancy greater than 10 years, in whom active surveillance has not maintained its defined monitoring targets.

Clinical Scenario
  • ISUP grade group 1, PSA <10 ng/mL, clinical stage cT1–2a
  • Life expectancy >10 years
  • Male sex
  • Previously on active surveillance
Why Active Surveillance Was No Longer Adequate
The prior management — active surveillance with regular PSA monitoring, MRI, and repeat biopsies — did not achieve its required targets. Specifically, one or more of the following was observed:
  • PSA did not remain stable
  • ISUP grade group upgrading on repeat biopsy
  • Disease progression on MRI
Failure to maintain these surveillance endpoints triggers escalation to a definitive intervention.
Treatment Approach — Partial Preview
Once surveillance targets are no longer met, this protocol calls for a definitive local intervention — either a surgical or a radiation-based approach — with the clinical goal of achieving an undetectable serum PSA. The complete regimen, modality selection criteria, and all decision points are available in the full protocol below.
Instant Access to Structured Evidence-Based Regimens

References

Active surveillance should be considered standard of care for all patients with a life expectancy > 10 years (based on comorbidities and age) and where curative treatment would be considered in the case of disease progression.

Manage patients with a life expectancy > 10 years and low-risk disease with active surveillance.

Other treatments, such as whole-gland therapy (e.g. RP or RT) or focal ablative therapy, remain highly likely to be overtreatment in the setting of low-risk disease and should not be used outside a trial setting.

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