Active Surveillance or Treatment? Your Guide to Stage 1 Prostate Cancer Options

This guide is designed to provide you with an educational overview of your diagnosis, stage 1 prostate adenocarcinoma. The information presented here will serve as a foundation for productive conversations with your oncologist and the rest of your care team.

What is Stage 1 Prostate Adenocarcinoma?

Prostate adenocarcinoma is the most common type of prostate cancer, developing from the gland cells of the prostate. Your specific diagnosis, stage 1, means the cancer is small, localized, and confined entirely within the prostate gland. It is not aggressive and has not spread to lymph nodes or distant organs.

This early stage is often detected through routine screenings, such as a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE), before any symptoms arise. Because the disease is limited, the prognosis for stage 1 prostate cancer is generally excellent.

The two main factors used to classify your cancer are:

• TNM Classification: This system describes the tumor size, node involvement, and metastasis (spread). For stage 1 disease, the classification is typically T1 or T2a, N0, M0.
• Gleason Score: This score, ranging from 6 to 10, is based on how abnormal the cancer cells look under a microscope. A lower score (e.g., 6) indicates slower-growing, less aggressive cancer. Your Gleason score is crucial for determining the best treatment path for your prostate cancer.

How is Prostate Cancer Diagnosed?

The initial suspicion of prostate cancer is often raised by an elevated PSA level or an abnormal DRE. To confirm the diagnosis and determine the stage, the following procedures are used:

• Prostate Biopsy: This definitive procedure involves taking small tissue samples from the prostate. These samples are then analyzed by a pathologist to confirm the presence of adenocarcinoma and determine the Gleason score.
• Imaging Tests (if necessary): For stage 1 cancer, advanced imaging is often not required as the risk of spread is very low. However, tests like a bone scan or CT scan might be used in select cases, particularly if the Gleason score is higher or PSA is very elevated, to ensure the cancer is indeed localized.
• Risk Stratification: Your oncologist will combine your PSA level, Gleason score, and clinical stage (T-stage) to classify your cancer into a risk group (very low, low, intermediate, or high). Stage 1 often falls into the very low or low-risk category, which directly influences treatment recommendations.

What is the Prognosis for Stage 1 Prostate Cancer?

The prognosis for Stage 1 prostate adenocarcinoma is highly favorable.

• Excellent Survival Rates: Because the cancer is localized, the five-year survival rate is nearly 100% for patients with early-stage prostate cancer.
• Low Risk of Progression: The cancer is generally slow-growing and has a low likelihood of spreading or causing significant health issues if properly managed.
• Cure Is Often Possible: Treatment, if pursued, is often curative.

Your specific long-term outlook will be discussed with your oncologist, considering your Gleason score, PSA level, age and overall health.

“A prostate cancer diagnosis can obviously be very devastating, but the nice thing to know is that it's one of the most treatable cancers out there,” Dr. Ravi Munver, vice chair of Urology, the chief of Minimally Invasive and Robotic Surgery, the director of Robotic Surgery and Minimally Invasive Urological Oncology Fellowship, and the director of the Living Donor Kidney Surgery Program, all at the John Theurer Cancer Center, part of Hackensack Meridian Health, as well as a professor of urology at the School of Medicine and vice chair of the Department of Urology at Hackensack University, said in an interview with CURE.

“So, when patients come to see their caregiver to talk about prostate cancer, they should first do their research. There's a lot of research you can do — you can go on the internet; you can talk to friends and family.”

Treatment Options for Stage 1 Prostate Adenocarcinoma

For stage 1, low-risk prostate cancer, there are typically three main approaches. The choice of treatment involves weighing the potential side effects of intervention against the slight risk of cancer progression.

Active Surveillance: This is often the preferred option for very low- and low-risk stage 1 cancer. What is active surveillance? Instead of immediate treatment, the cancer is closely monitored with regular PSA tests, DREs, and periodic confirmatory biopsies. The goal is to defer or avoid the side effects of treatment (such as urinary, bowel, and sexual dysfunction) while ensuring that curative treatment can be started if the cancer shows signs of progression.

Dr. David A. Taub, a urologist and the director of urologic oncology at Eugene M. & Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital, part of Baptist Health, explained in an interview with CURE that some international studies have shown that some of these earlier-stage and non-aggressive cancers can be present for 10 or 15 years without causing any increase in death or complications.

“So, watching the cancer and surveilling it is an option,” Taub said. “We do that by checking the PSA on a more regular basis, about twice a year, and checking the MRI a little more frequently, as well as repeating biopsies to make sure nothing is progressing. Active surveillance is the mainstay for low-risk prostate cancer.”

1. Radical Prostatectomy: A surgical procedure to remove the entire prostate gland and sometimes surrounding lymph nodes. It can be performed through an open incision or robotically. The goal is to remove the cancer entirely.
2. Radiation Therapy: Using high-energy beams to kill cancer cells. This can be delivered externally through external beam radiation therapy or internally through implanted radioactive seeds with brachytherapy. The goal is to destroy the cancer within the prostate.

The most important discussion with your oncologist will be around active surveillance. Given the low-risk nature of stage 1 disease, many patients can safely postpone or avoid aggressive treatment.

How to Live With Stage 1 Prostate Cancer

Managing your diagnosis is an ongoing process that extends beyond treatment decisions.

• Understanding Side Effects: If you choose treatment, be prepared to discuss potential side effects, especially those affecting urinary function, bowel function, and sexual health. Your care team can provide rehabilitation and support for managing these.
• Emotional Health: A cancer diagnosis can be stressful. Seek support from family, friends, support groups, or a mental health professional. Many patients find it helpful to focus on the excellent prognosis for their stage.
• Lifestyle Changes: Maintaining a healthy lifestyle is always beneficial. This includes a balanced diet, regular exercise and limiting alcohol intake. While these won't cure the cancer, they support overall health and well-being.
• Follow-Up Care: Regardless of your chosen path (active surveillance or definitive treatment), regular follow-up with your oncologist is critical. This typically involves ongoing PSA monitoring to ensure the cancer remains stable or is gone.

Moving Forward With Stage 1 Prostate Cancer

Stage 1 prostate adenocarcinoma is a highly treatable, low-risk cancer. Patients have time to carefully consider their options.

Your primary goal should be an open, honest dialogue with your oncologist to determine the best approach for you, one that balances the certainty of treatment side effects against the low risk of cancer progression. Be sure to ask about your specific Gleason score and risk group classification and discuss active surveillance in detail. Taking an active role in these decisions is the first step on your journey toward successful management and recovery.

References

1. “Making Prostate Cancer Easier to Understand for Those Newly Diagnosed.” CURE, June 26, 2025. https://www.curetoday.com/view/making-prostate-cancer-easier-to-understand-for-newly-diagnosed-patients
2. “Empower Yourself: What to Know After a Prostate Cancer Diagnosis.” CURE, Sept. 5, 2025. https://www.curetoday.com/view/empower-yourself-what-to-know-after-a-prostate-cancer-diagnosis
3. “Expert Outlines Prostate Cancer Treatment Options for Awareness Month.” CURE, Sept. 1, 2025. https://www.curetoday.com/view/expert-outlines-prostate-cancer-treatment-options-for-awareness-month

Editor’s Note: This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

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