Yes indeed! Active Surveillance should be very ACTIVE but I am afraid many men, being how we are, don't want to face what we heard and so just follow blindly what the URO says. I have seen this quite a bit on various cancer boards where people just waited and waited, until some 'number' was met and then did something. Often times, that may be too late or it may be they are now in a grueling treatment plan.

I am a huge fan of transperineal biopsy and tell men that if your doctor does not do it, then find a doctor that will, even if you have to drive 6 hours to the doctor. Pros and cons to a 30 core saturation biopsy in that a lot of indolent cancers can be found, cancers you will die with and not from, but at least you know it is there. I had 9 cores positive and the cancer, though low grade was widespread. I did not sweat the 1 percent positive samples, though not happy about it, but the two tumors had me real concerned. Two URO's thought I should do a treatment and one did not. I think I am on URO number 5 now ... I tend to irritate them I think. Nothing they hate worse is an informed patient. 🙂

When I went on AS I told my then URO that I considered AS as a deferred treatment plan and that I would be doing something in the next 18 months. I tell anyone that will listen, if they are on AS use that time to find a definitive or at least a palatable treatment and do the treatment in 18 months or at least have a treatment plan and watch, like you say, MRI every 6 to 9 months, PSA every 3 to 6 months, and a transperineal biopsy if any of the MRI begin to look more suspicious. Really, once the MRI begins to look really suspicious, the person could probably forgo the biopsy and just go into a treatment.

Every man needs to be proactive and to have a plan. Don't let the situation get worse by 'holding out', in many cases that is not going to end well.