Low Risk and Favorable Intermediate Risk for Prostate Cancer

Authored by Tyler Seibert, published on 2026-04-30 01:53:34.0

Selection and follow-up for men with low-risk and select favorable intermediate-risk prostate cancer. Tyler Seibert, MD, PhD, Genitourinary Section Chief at UC San Diego Radiation Oncology outlines criteria based on risk group, pathology features, and imaging, followed by a structured monitoring plan using PSA, MRI, and biopsy. The goal is to safely delay treatment while identifying progression early and transitioning to definitive therapy when needed.

  1. High-quality MRI if not done already
    • Targeted biopsy, if not done already (or low confidence in results)
      • NCCN low risk
        • Active Surveillance (AS)
          • Year 1 -- 1. PSA q3 months. If concerning rise, repeat MRI, and consider biopsy 2. MRI at 12 months 3. No routine DRE
            • Years 2+: 1. PSA q6 months. If concerning rise, repeat MRI, consider biopsy. 2. Routine MRI every year for GG2, every other year for GG1
      • NCCN intermediate risk, GG1
        • Active Surveillance (AS)
          • Year 1 -- 1. PSA q3 months. If concerning rise, repeat MRI, and consider biopsy 2. MRI at 12 months 3. No routine DRE
            • Years 2+: 1. PSA q6 months. If concerning rise, repeat MRI, consider biopsy. 2. Routine MRI every year for GG2, every other year for GG1
      • NCCN favorable intermediate, GG2
        • Pathology review if not confident about cribriform status
          • Cribriform (including IDC)
            • RT + stADT
          • 40% pattern 4 No cribriform
            • Active Surveillance (AS)
              • Year 1 -- 1. PSA q3 months. If concerning rise, repeat MRI, and consider biopsy 2. MRI at 12 months 3. No routine DRE
                • Years 2+: 1. PSA q6 months. If concerning rise, repeat MRI, consider biopsy. 2. Routine MRI every year for GG2, every other year for GG1
            • RT or RP
          • ≤35% pattern 4 No cribriform (including IDC)
            • Active Surveillance (AS)
              • Year 1 -- 1. PSA q3 months. If concerning rise, repeat MRI, and consider biopsy 2. MRI at 12 months 3. No routine DRE
                • Years 2+: 1. PSA q6 months. If concerning rise, repeat MRI, consider biopsy. 2. Routine MRI every year for GG2, every other year for GG1
            • RT or RP
tosprivacyNCCN Prostate Cancer GuidelinesMagnetic Resonance Imaging–led Risk-adapted Active Surveillance for Prostate Cancer: Updated Results from a Large Cohort StudyMRI and active surveillance: thoughts from across the pond