Basically, intermediate risk, Gleason 7(3+4) is either 'favourable' or 'unfavourable' for AS.
Those deemed favourable:
If the cancer has low volume and lacks aggressive architectural traits. No cribriform, or intraductual or perineural invasion
A very low amount of Gleason pattern 4—typically less than 10% of the total cancer volume (or 5% or less in many strict protocols).
Core Involvement: Cancer is found in only a small number of biopsy cores.
PSA Levels: under 10 ng/mL.
MRI Findings: Shows localized disease (e.g., clinical stage T2a)
Those deemed unfavourable.
Grade 4 Percentage: A higher proportion of Gleason pattern 4 approaching or exceeding 10% to 50% of the core sample. (Gleason 7 (4+3) Grade Group 3, it is automatically classified as unfavorable)
Core Involvement: Involvement of multiple biopsy cores or bilateral disease (cancer in both lobes)
Higher PSA levels, typically in the 10 to 20 ng/mL range (or rising rapidly).
MRI scans showing tumours in both lobes of the prostate or extension past the prostate capsule (T2c, or higher).
Presence of cribriform growth patterns, perineural invasion, or intraductal carcinoma.
In Rachel's opening post she mentions that her husband has been deemed suitable for AS, and that it is his prefered treatment option.
In answer to her question, "Is there any questions that I could ask the specialist nurse?"
To double-check that AS was an option for her husband. I'd be asking how many of his biopsy cores were postive and what percentage were grade 4. I'd also be asking why, when he has T2c disease, cancer in both lobes, they are considering AS.
If you look at my bio, you'll see that I was initially diagnosed, PSA 5.6, T2a, prostate confined, apparently low volume, low grade, Gleason 6 (3+3) prostate cancer. I appeared to be the perfect candidate for AS.
The MDT recommended AS and I opted for it.
Only two years later, a very delayed follow up MRI resulted in a second biopsy, which revealed significant disease progression. I was now in a very precarious position. PSA only 7, but Gleason 8 (3+5), later upgraded to Gleason 9. (4+5), capsular breach (EPE extracapsular extension) T3a staging.
If anyone should be advising against AS, you'd have thought it would be me, but I'm not. I believe my AS failed because, my initial diagnosis was incorrect. I was T2c (cancer in both prostate lobes) not T2a. My biopsy missed the higher grade cancer cells and my follow up monitoring was woeful.
https://community.prostatecanceruk.org/posts/t29997-T2c-disease-and-active-surveillance
The biggest trial involving AS was the Protect trial, comparing the outcomes of those on AS to those having radiotherapy and HT, and those having surgery. The outcomes were very similar for all three groups. Those on AS were initially thought to be all Gleason 6, but research has shown that almost 20%, some say even much higher, were Gleason 7 (3+4) or greater. Ten years later, 44% of those on AS had no need for further radical treatment.
As I said before, you often see horror stories of AS on this forum, but they are the exception not the rule.
AS is often portrayed on here as 'only kicking the can down the road', that's simply unfair. Many men on AS never need further treatment and for those that do, being on it has often given them years of being free from side effects from radical treatments.
Of course its always beneficial to be catch prostate cancer as soon as possible, but for many men, trying to obliterate it at all costs, is not the answer.
For a far more balanced and researched opinion on AS, people would be better advised to read our site's thoughts on it, rather than relying on anecdotal evidence.
https://prostatecanceruk.org/for-health-professionals/resources/active-surveillance-hub/evidence-based-resources
Edited by member 12 Nov 2026 at 20:31
| Reason: Add link