My understanding of the purpose of Active Surveillance is to monitor the potential for PCa progression, it's much different than what is called "watchful waiting".

First and foremost, after initial diagnosis, a 3+3 (GG1) or 3+4 (low volume GG2) MUST be confirmed...before one can truly be sure long-term AS is the best option. I think this last point is why many men do not feel comfortable choosing the road to AS - and it's perfectly understandable. Waiting for confirmation that AS is the right choice for 12 months is not for the faint of heart, especially at the beginning when one is on the steep end of the learning curve.

The proper AS protocol, during the first year after initial biopsy, includes:

1) PSA testing every three to six months (every 3 months is better).
2) A digital rectal exam (DRE) within the first 12 months.
3) A confirmational biopsy within the first six to 12 months.

If the 2nd biopsy confirms the first; then AS can continue with additional follow-up biopsies at least every two to five years. Although follow-up mpMRI's are recommended prior to follow-up fusion biopsies (but not more than every 1-2 years); they are not to be relied up as a substitute for biopsy (at least not yet).

If the confirmational biopsy indicates progression, it's likely the more aggressive cancer was missed in the initial biopsy and the initial diagnosis was wrong! However, I would argue that the AS protocol worked even in the "within 12 month progression" cases, because it's still early enough to proceed with active treatment AND the patient had much more time to consider his situation, research his treatment options and gain more confidence regarding the treatment type ultimately selected.

I've heard stories from folks, like yourself, who did not continue AS past the confirmational biopsy upon seeing a "missed" aggressive cancer situation. I also know of many that have gone 5, 10, 15 and even 18 years and are still on AS...it's a very diverse group. In fact, you can read about the 5, 10 and 15 year progression-free percentages of men who originally opted for AS.

AS uncertainties need to be weighed against a man's personal assessment of the risks of treatment side-effects, and again, I've heard fantastic success stories and absolute horror stories of men who have had all the various traditional treatments options.

Unfortunately, with PCa there are no guarantees with any treatment or AS decision.

In any case, I wish you all the wisdom and success a man can hope for as you continue your PCa journey.