Low-Risk Diagnosis & Surveillance Selection
A low-risk finding opens the door to watching, not treating, right away.
- <10: Baseline PSA (ng/mL threshold)
- GG1: Grade Group (Gleason 3+3)
- T1c–T2a: Clinical Stage (organ-confined)
- ~50%: AS eligibility (US) (of new diagnoses)
Why watch instead of treat
Many low-grade tumors grow slowly and may never cause harm.
Overtreatment risk drove the shift toward surveillance protocols.
Eligibility criteria
Low PSA, low Gleason grade group, small tumor volume on biopsy.
Shared decision-making
Patient and physician weigh side effects against indolent-disease risk.
Regular PSA, Biopsy & MRI Checkpoints
A fixed monitoring schedule replaces immediate treatment with close watching.
- 3–6 mo: PSA check interval (blood draw)
- ~12 mo: Repeat biopsy (confirmatory, then periodic)
- ~12–24 mo: MRI interval (mpMRI surveillance)
- Annual: Digital rectal exam (physical check)
PSA checkpoints
Frequent blood draws track velocity and doubling time over time.
Biopsy checkpoints
Repeat biopsies confirm grade has not progressed since diagnosis.
Grade upgrade on repeat biopsy is a key escalation signal.
Imaging checkpoints
MRI screens for new or growing lesions between biopsies.
Monitoring Continues Without Progression
When every checkpoint stays quiet, surveillance simply continues.
- <10: Stable PSA range (ng/mL, slow rise)
- GG1: Grade on repeat (unchanged)
- No lesion: MRI status (PI-RADS ≤2)
- Ongoing: Treatment avoided (no side effects yet)
Reassuring pattern
Flat PSA trend and unchanged grade support continued watching.
Avoiding overtreatment
Indolent disease may never need surgery or radiation.
Stable years on surveillance spare patients treatment side effects.
Continued vigilance
Monitoring keeps running even while results stay reassuring.
Escalation Trigger Thresholds
Three independent signals can each flip the decision toward treatment.
- Rising fast: PSA trigger (velocity threshold)
- GG upgrade: Biopsy trigger (e.g. GG1→GG2+)
- New lesion: MRI trigger (PI-RADS 4–5)
- OR logic: Any one suffices (not all required)
PSA rise trigger
A steep or sustained PSA rise signals possible progression.
Gleason upgrade trigger
A more aggressive pattern on repeat biopsy reclassifies risk.
Any single trigger — PSA, biopsy, or MRI — is enough.
MRI lesion trigger
A new suspicious lesion prompts targeted rebiopsy or escalation.
Escalate to Treatment or Continue Surveillance
The decision pathway branches on whether any trigger has fired.
- Surgery / RT: Escalation path (active treatment)
- Surveillance: Continue path (no treatment yet)
- Any trigger: Decision rule (moves to treatment)
- Right-size care: Goal (treat only if needed)
Escalate branch
A fired trigger moves the patient toward definitive treatment.
Continue branch
No trigger keeps the patient on the surveillance loop.
The goal: treat aggressive disease, spare indolent disease.
Ongoing reassessment
Every cycle re-evaluates PSA, biopsy, and MRI checkpoints again.