New Research Reinforces Active Surveillance as Safe Option for Localized Prostate Cancer

Groundbreaking Korean Study Adds International Evidence to Support Active Surveillance

Bottom Line First

A major new study from Korea provides reassuring evidence that active surveillance/watchful waiting (AS/WW) is as safe as surgery or radiation for men with localized prostate cancer, with survival rates exceeding 99% across all treatment approaches over 4.4 years of follow-up.

The Study at a Glance

Researchers from multiple Korean institutions, including Ajou University and Stanford University, published groundbreaking results in July 2025 that should provide significant comfort to men considering active surveillance for their prostate cancer diagnosis.

What They Found:

  • Excellent survival rates across all treatments: 99.8% survived prostate cancer specifically, and 98.8% survived from all causes
  • No significant difference in mortality between active surveillance, surgery (prostatectomy), or radiation therapy
  • Comparable metastasis rates among all three approaches
  • Lower depression medication use among men who chose surgery or radiation compared to active surveillance

The study followed 8,036 Korean men aged 50-69 with localized prostate cancer diagnosed between 2012-2020, using Korea's comprehensive national health database. After careful matching to ensure fair comparisons, researchers analyzed outcomes for:

  • 1,191 men who underwent surgery vs. 1,191 on active surveillance
  • 428 men who received radiation vs. 428 on active surveillance

Why This Study Matters

Global Validation: This is the first major study to validate the famous ProtecT trial results in an Asian population, providing crucial evidence that active surveillance safety transcends ethnic and healthcare system boundaries.

Real-World Evidence: Unlike clinical trials with strict enrollment criteria, this study used Korea's national healthcare database, capturing how treatments perform in everyday medical practice.

Healthcare System Insights: Korea's single-payer system provided unique advantages, ensuring consistent access to screening, diagnosis, and treatment that may help explain why survival differences between treatments were minimal.

Supporting Evidence from Recent Research

This Korean study aligns with a growing body of international evidence supporting active surveillance:

The ProtecT Trial Updates

The landmark ProtecT trial, recently updated with 15-year follow-up data, continues to show that "mortality from PSA-detected prostate cancer remained very low regardless of whether men had been assigned to receive active monitoring, prostatectomy, or radiotherapy." Even after 15 years, only 2.7% of men died from prostate cancer across all treatment groups, with no significant differences between approaches.

Long-Term Active Surveillance Outcomes

Recent analysis of protocol-directed active surveillance showed that "10 years after diagnosis, 49% of men remained free of progression or treatment, less than 2% developed metastatic disease, and less than 1% died of their disease." These excellent outcomes reinforce that many men can safely delay or avoid treatment altogether.

The Mental Health Connection: A Complex Picture

One of the most intriguing findings from the Korean study was that men who chose surgery or radiation were less likely to start antidepressant medications compared to those on active surveillance. This finding sparked important discussions about the psychological aspects of cancer management.

Recent Mental Health Research Reveals Nuanced Picture

However, other recent studies provide a more complex view of mental health and active surveillance:

Pre-existing Mental Health Matters: A 2025 study found that "men with a prior mental health diagnosis were significantly less likely to adhere to active surveillance than those without such a diagnosis (27.6% vs. 49.5%)" and "were more likely to abandon active surveillance in favor of immediate treatment."

Population Studies Show Different Results: A large French population study found "no significant association between depressive symptoms and anxiety and the treatment received" when comparing active surveillance to surgery or radiation at 5 years after diagnosis.

Systematic Reviews Are Encouraging: A comprehensive review of 34 studies with 12,497 patients "suggested that rates of anxiety and depression in AS groups are either lower or equivalent to rates in population control groups, showing that remaining on AS does not negatively impact mental health."

What This Means for Asian Men with Prostate Cancer

The Korean study is particularly significant because prostate cancer research has historically been dominated by Western populations. As researchers note, "Asia comprises 60% of the global male population, yet Asian men's health issues, such as prostate cancer, remain sparse in the literature."

Rising Concerns in Asia

Prostate cancer incidence is rising across Asia, with estimates that "by 2030, the number of new cases and deaths of prostate cancer in China will exceed 315,310 and 81,540, respectively." Meanwhile, "the International Agency for Research on Cancer predicts that the overall number of new cancer cases in Asia will reach 11.5 million by 2030."

Screening and Early Detection Disparities

Significant challenges remain across Southeast Asian countries, where "developing SEA countries such as the Philippines, Malaysia, and Thailand had a mortality-to-incidence ratio that was more than twice as high as Japan and South Korea," highlighting the importance of early detection and appropriate treatment selection.

Current Guidelines and Expert Recommendations

2025 Treatment Landscape: Leading experts predict that "in 2025, we are likely to see data from trials offering completely novel approaches to treatment, and doctors and patients will have more choices than ever before."

Quality of Life Considerations: The ProtecT trial's quality of life analysis showed significant differences in how treatments affect daily functioning, with surgery having the greatest impact on urinary and sexual function, while radiation primarily affected bowel function.

Key Takeaways for Patients and Families

  1. Safety is Comparable: Multiple large studies now confirm that active surveillance is as safe as immediate treatment for appropriately selected men with localized prostate cancer.
  2. Mental Health Support Matters: While active surveillance is psychologically safe for most men, those with pre-existing anxiety or depression may benefit from additional mental health support during their cancer journey.
  3. International Evidence is Consistent: The safety of active surveillance has now been demonstrated across different healthcare systems, ethnic populations, and time periods.
  4. Individual Decision-Making: The choice between active surveillance and immediate treatment should consider personal factors including anxiety tolerance, family history, and life goals.

Looking Ahead

The 2024 Advanced Prostate Cancer Consensus Conference identified several areas where "we continue to lack high-level evidence on a variety of topics that greatly impact daily practice," emphasizing the need for continued research to refine treatment recommendations.

For Active Surveillance Specifically: Future research priorities include optimizing monitoring protocols, identifying men most likely to benefit from delayed treatment, and developing better tools to predict which cancers will remain indolent.

Questions for Your Doctor

Based on this research, consider discussing with your healthcare team:

  • Am I a good candidate for active surveillance based on my specific cancer characteristics?
  • What monitoring schedule would be appropriate for my situation?
  • How might my mental health history factor into treatment decisions?
  • What support resources are available if I choose active surveillance?
  • How do these findings apply to my individual risk factors and preferences?

Sources and Citations

  1. An, M. H., Kim, C., Min, K., Yi, K. H., Park, R. W., & Jung, M. (2025). Survival Outcomes after Monitoring, Surgery, or Radiotherapy for Clinically Localized Prostate Cancer. medRxiv, 2025.07.16.25331661. https://doi.org/10.1101/2025.07.16.25331661
  2. Hamdy, F. C., Donovan, J. L., Lane, J. A., et al. (2023). Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. New England Journal of Medicine, 388(17), 1547-1558. https://www.nejm.org/doi/full/10.1056/NEJMoa2214122
  3. Newcomb, L. F., Schenk, J. M., Zheng, Y., et al. (2024). Long-term outcomes in patients using protocol-directed active surveillance for prostate cancer. JAMA, 331(24), 2084-2093. https://pubmed.ncbi.nlm.nih.gov/38814624/
  4. Taylor, Z., Meyer, K., Terrenzio, D., et al. (2025). Mind matters: how anxiety and depression shape low-risk prostate cancer active surveillance adherence in a real-world population. Canadian Journal of Urology, 32(1), 21-27. https://www.techscience.com/CJU/v32n1/60059
  5. Margue, G., Marchand, C., Petit, A., et al. (2022). Impact of active surveillance for prostate cancer on the risk of depression and anxiety. BMC Cancer, 22, 805. https://pmc.ncbi.nlm.nih.gov/articles/PMC9334351/
  6. Abdo, J., Haigh, M. M., Miladinovic, A., et al. (2025). Rising trends in prostate cancer among Asian men: Global concerns and diagnostic solutions. Cancers, 17(6), 1013. https://www.mdpi.com/2072-6694/17/6/1013
  7. Han, D., Cao, Z., Fan, Y., et al. (2024). Hot issues on Chinese expert consensus of prostate cancer management. UroPrecision, 2024. https://onlinelibrary.wiley.com/doi/10.1002/uro2.76
  8. Chiong, E., Saad, M., Hamid, A. R. A. H., et al. (2024). Prostate cancer management in Southeast Asian countries: A survey of clinical practice patterns. Therapeutic Advances in Medical Oncology, 16, 17588359231216582. https://journals.sagepub.com/doi/10.1177/17588359231216582
  9. ZERO Prostate Cancer. (2025). Advanced Prostate Cancer Newsletter 2024/2025. https://zerocancer.org/newsletters/advanced-prostate-cancer/2024-2025

Disclaimer: This newsletter article is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider about treatment decisions specific to your situation.

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Survival Outcomes after Monitoring, Surgery, or Radiotherapy for Clinically Localized Prostate Cancer | medRxiv

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