Active Surveillance for Prostate Cancer — Arlington & DFW
Safely monitor low-risk disease. Protect your quality of life.
Dr. Rich Bevan-Thomas is a board-certified urologist and experienced surgeon in Arlington & DFW. For men with low-risk and select favorable-intermediate prostate cancer, we recommend Active Surveillance (AS). AS is an evidence-based, modern plan that allows us to safely and expertly monitor your cancer. As a surgeon, my priority is ensuring you receive the right treatment at the right time, protecting your long-term outcomes while helping you avoid or delay unnecessary treatment side effects.
Who is a Good Candidate for Active Surveillance?
You’re often a great fit for Active Surveillance if you have:
- Low-risk disease (Grade Group 1 / Gleason 6), PSA <10 ng/mL, clinical stage T1c–T2a, low tumor volume, and a PSA density that is favorable for observation.
- Favorable-intermediate disease in very limited volume may also qualify after deeper review (favorable intermediate active surveillance).
Many physicians rely solely on basic pathology results to determine Active Surveillance candidacy.
Dr. Bevan-Thomas utilizes a modern, multi-modal assessment to evaluate your true risk of progression. We combine:
Pathology (Gleason Score/Grade)
Advanced MRI Imaging (Visual Confirmation of Confinement)
Selective Genetic/Genomic Testing (Molecular Risk)
Crucially, this is a shared decision. We will personally review your MRI scans with you—not just tell you the results—so you are fully educated and confident in our joint decision about your Active Surveillance plan.
Pathology and Biopsy
The Gleason grade/group and tumor volume provide the foundational risk profile used to begin the assessment process.
PSA & PSA density
We assess PSA relative to prostate size (PSA Density) to distinguish true low-risk cancer from cases with higher tumor burden.
Advanced MRI findings
High-resolution multi-parametric MRI (mpMRI) provides visual confirmation that the cancer is truly small and clinically insignificant.
Genomic testing
| When appropriate, tests like Decipher®, Oncotype DX GPS, and Polaris® provide molecular confirmationof low biological risk to refine and secure the AS plan. |
Only when your cancer is confirmed as small, low-grade, and truly confined—validated by Pathology, Imaging, and Molecular Data—is Active Surveillance the informed and preferred starting point.
Our Modern Active Surveillance Program (Arlington)
| Our program is designed for confidence and clarity. We utilize the most advanced tools—including MRI-guided targeting and fusion biopsy when indicated—to ensure every step of your schedule is precise. You will always know what to expect. |
| Treatment | Cadence | Purpose |
|---|---|---|
| PSA | Every 6 months (fixed cadence; sooner if there’s a concern). | Tracking overall prostate activity. |
| DRE (Exam) | About once a year. | Checking for palpable changes. |
| mpMRI | Every 1–3 years, or sooner if PSA/exam changes. | Visual mapping of the prostate and tumor area. |
| Confirmatory Biopsy | Usually 6–12 months after diagnosis (using MRI-targeted fusion biopsy). We perform this at one year regardless of initial results. | Validating the low-risk status. This crucial step ensures no higher-grade cancer was missed initially, securing patient safety for long-term Active Surveillance. |
| Subsequent Biopsies | Every 1–4 years based on risk (PSA density, MRI, prior results) or earlier if anything changes. | Proactively detecting any grade progression. |
You’ll leave with a written timeline, and we’ll coordinate reminders so the schedule is easy to follow.
What Outcomes Should I Expect?
Vigilant low risk prostate cancer monitoring is key to success:
- Proven Long-Term Safety: Metastasis and prostate-cancer death are extremely rare when following a robust Active Surveillance protocol. Our data-driven approach offers excellent long-term safety for low-risk disease.
- Avoid or Delay Treatment: A substantial majority of men remain treatment-free for 10 years or longer, successfully preserving their quality of life while we continue expert monitoring.
- Precision Intervention: Our vigilance ensures we detect subtle changes early. This allows us to intervene at the ideal time, maximizing your cure rate while still minimizing the long-term impact of treatment side effects.
- High Success Rate: AS has strong durability: approximately 87% of men avoid further surgery at the five-year mark, confirming its effectiveness.
- Preserves All Future Options: By choosing AS now, you keep all definitive prostate cancer treatment options (like surgery or radiation) fully available if the situation evolves later.
With our advanced monitoring technology and precise schedule, Active Surveillance enables many men to avoid or delay definitive treatment for years—sacrificing nothing in terms of survival while ensuring all future options remain available.
When Would We Recommend Treatment?
Moving to definitive treatment is a careful, informed decision based on expert analysis. As an experienced surgeon, I recommend intervention only when our multi-modal surveillance detects clear evidence of disease progression, based on the following indicators:
- Biopsy Progression: A significant rise in the cancer's grade (e.g., progression to Grade Group ≥ 2 or the detection of pattern 4).
- Volume Progression: A clear, documented increase in the volume or extent of cancer found during surveillance biopsies.
- Biochemical Progression: Worrisome changes in PSA kinetics or a rising PSA density that is supported by other diagnostic evidence.
- Imaging Progression: The appearance of a new, larger, or more concerning lesion on mpMRI, confirmed by a positive targeted biopsy.
- Patient Preference: A personal decision to proceed with definitive treatment due to changes in your quality-of-life priorities or anxiety levels.
When it is time to act, you are already in the right place. Our team delivers comprehensive care right here in Arlington—from advanced options like catheterless robotic prostatectomy and focal therapy (NanoKnife®) to partnerships with experienced radiation oncologists for IMRT. We offer the full spectrum of modern treatment, ensuring we choose the right plan for you, not the tool.
Benefits of Choosing Active Surveillance
- Avoids Treatment Side Effects: AS allows you to avoid or delay the potential long-term side effects associated with immediate surgery or radiation, such as impacts on continence and sexual function.
- Maintains Normal Life: The schedule for AS consists of quick, office-based check-ups (PSA tests and office visits), allowing you to maintain your normal routine and quality of life.
- Evidence-Backed Safety: AS is a widely accepted, evidence-based strategy proven to be safe for men with appropriately selected low-risk disease, preventing unnecessary treatment.
- Keeps Future Options Open: By delaying intervention, you keep all definitive treatment options open (like surgery or radiation) should your disease progress and require action down the road.
Frequently Asked Questions
Is Active Surveillance safe for low-risk prostate cancer?
Yes, absolutely. When managed under a rigorous protocol (scheduled PSA, MRI, and periodic biopsy), the long-term cancer-specific survival for appropriate low-risk patients remains excellent and proven by data.
Will I definitely need treatment later?
Not necessarily. Our data shows a substantial majority of men successfully delay or avoid definitive treatment entirely. We only recommend treatment years later if the cancer shows clear evidence of progression.
How often are tests and biopsies on Active Surveillance?
Our structured schedule involves PSA every 6 months, DRE annually, mpMRI every 1–3 years, and a confirmatory fusion biopsy at one year. Subsequent biopsies are individualized and timed every 1–4 years based on ongoing risk assessment.
Do I need an MRI to be on Active Surveillance?
Yes, Advanced MRI is central to our protocol. MRI is essential for mapping, follow-up, and ensuring the cancer is truly contained. We utilize mpMRI every 1–3 years—or sooner—to provide the visual confirmation needed for safe surveillance.
Can favorable-intermediate risk ever do Active Surveillance?
Yes. For very limited-volume Grade Group 2 disease, Active Surveillance can be an option after a comprehensive review using mpMRI-targeted fusion biopsy and, crucially, selective genomic testing to confirm low biological risk.
If I leave AS and choose treatment, what are my options with you?
As a specialist surgeon, my patients have access to the full spectrum of modern treatment in Arlington: catheterless robotic prostatectomy, partnerships for IMRT, and focal options like NanoKnife® and cryoablation. We choose the plan that fits you, not the tool.