I agree patients need to work with their medical professionals to determine if they are candidates for active surveillnce. It is also important to note that active surveillance is not a fringe idea found only on videos and podcasts. It is part of standards that guides urlogists nationwide. For someone newly diagnosed with low-volume Gleason 3+4 disease, the current NCCN and AUA guidelines support considering active surveillance—but only after confirming that the patient truly has favorable intermediate-risk disease. Many men (and even some physicians) still think "3+4 means you need treatment," whereas the guidelines have evolved considerably.

Current NCCN and AUA guidelines recognize that carefully selected men with low-volume Gleason 3+4 (Grade Group 2) prostate cancer may be appropriate candidates for active surveillance. Patients most likely to be suitable have - as others have indicated - favorable intermediate-risk disease, including a small amount of Gleason pattern 4, low tumor volume, low PSA density, favorable MRI findings, and favorable genomic testing. Active surveillance is not recommended for patients with adverse features such as extensive pattern 4, high tumor volume, unfavorable genomic classifiers, cribriform or intraductal carcinoma, or other signs of more aggressive disease. Treatment decisions should be individualized after discussion with an experienced urologist who is up to date with the current standards on active surveillance.