Active Surveillance in Prostate Cancer—and 5 Other Things Employers Should Know About This Cancer

Prostate cancer is the most commonly diagnosed cancer among men in the U.S., according to the American Cancer Society. Experts estimate that, in 2026, almost 334,000 men in the U.S. will receive a prostate cancer diagnosis. This type of cancer develops when cells in the prostate—a small gland that produces part of the fluid in semen—begin growing and dividing abnormally.

But a diagnosis doesn’t mean the same thing for every man. Some prostate cancers grow so slowly they’ll never cause symptoms or need treatment. Others are aggressive and require immediate action. Put simply, prostate cancer doesn’t come with a single treatment playbook that applies to everyone.

Here’s what HR and benefits leaders should know about prostate cancer so they can help ensure employees get the right care—without dealing with (or paying for) more than they need.

1. Most prostate cancers are caught early, and many are slow-growing

Prostate cancer is frequently caught before it spreads. According to the National Cancer Institute, nearly seven in ten prostate cancer cases are caught while still in the localized stage—meaning the cancer is still confined to the prostate and hasn’t spread to nearby tissue or anywhere else in the body.

In contrast, only 9% of prostate cancers have metastasized at the time of diagnosis. Compare that to the 23% of colorectal cancers that are diagnosed after the cancer has spread to distant tissues and organs, and it’s proof that prostate cancer is more likely to be flagged early than many other cancers.

When it’s caught at the localized or regional stage (which means it’s only spread to nearby tissue or lymph nodes, but no further), prostate cancer’s five-year relative survival rate is close to 100%.

Many prostate cancers are also fairly mild. Roughly half of prostate cancer diagnoses receive a Gleason score of 6 (also called Grade Group 1). That’s the least aggressive classification on a grading system doctors use to grade how abnormal the cancer cells look and how quickly they’re likely to grow.

It’s all good news. Because prostate cancers are often caught early and are low-grade, a diagnosis doesn’t always mean aggressive treatment.

2. Risk of prostate cancer isn’t distributed evenly

Yes, prostate cancer is lower risk than many other cancers—but that doesn’t mean the risk is equal for every man. Some men face higher odds of a prostate cancer diagnosis than others, largely based on factors outside their control.

Race is one of the strongest risk factors, and Black men are diagnosed with prostate cancer at significantly higher rates than white men. The average annual incidence rate was 191.5 prostate cancer cases per 100,000 Black men vs. 114.5 per 100,000 white men. That’s 67% higher.

Researchers haven’t pinned down a single cause for these differences. It’s likely a mix of things, including ancestry-linked genetic differences and disparities in healthcare access and screening rates.

Age matters too, as risk increases later in life. About six in 10 prostate cancer cases are diagnosed in men 65 and older, and it’s rare to be diagnosed before age 40.

Finally, family history also plays a big role. Having a first-degree relative—like a father or brother—with prostate cancer more than doubles a man’s odds of diagnosis. That likelihood is even higher if it was a brother who had it, compared to a father. And then risk compounds further if a man has several relatives who had prostate cancer, especially if those relatives were young when they were diagnosed.

Risk isn’t random or even, and a one-size-fits-all approach to prostate cancer education won’t serve everyone equally well.

3. Screening guidance has shifted (and is still debated)

Prostate cancer screening guidance has changed a few times over the past 15 years, which has caused quite a bit of confusion among patients, payers, and even providers.

In 2012, the U.S. Preventive Services Task Force (USPSTF) advised against routine prostate-specific antigen (PSA)-based screening for all men. This task force gave PSA-based screening a “D” grade, its lowest rating, largely because it concluded that the harms of routine screening (like overtreating slow-growing or low-risk cancers) outweighed the benefits.

Unfortunately, some research suggests the pullback on screening went a little too far. The American Cancer Society found that new prostate cancer cases rose 3% per year from 2014 to 2022, with the steepest increase in advanced-stage diagnosis. Some researchers tie that trend back to fewer men being screened after the 2012 guidance change.

In 2018, the USPSTF revised that rating to a “C” grade and recommended that men ages 55 to 69 work with their doctors to make individual decisions about screening. It still advises against routine screening for men 70 and older.

Some of this back-and-forth is understandable, since screening recommendations are a bit of a tightrope walk. Yes, screening tends to catch cancer earlier. But it can also trigger treatment that’s ultimately unhelpful, adds cost, or causes other complications for patients.

There’s no widely agreed-upon standard for men to follow when it comes to screening for prostate cancer, and conversations about these recommendations can vary a lot depending on who’s having them. So, guidance often feels like it comes down to luck of the draw.

4. Some prostate cancer can be monitored instead of treated immediately

A prostate cancer diagnosis doesn’t always mean immediate treatment. Particularly for men with low-risk, localized prostate cancer, doctors increasingly recommend active surveillance. It’s exactly what it sounds like: Closely watching the cancer over time instead of jumping right into treatment. This typically involves regular PSA blood tests, physical exams, MRI imaging, and periodic biopsies to check whether the cancer is growing and changing. If the cancer starts to progress, treatment can begin.

It’s important to note that active surveillance doesn’t mean ignoring a prostate cancer diagnosis. It’s a structured, monitored approach supported by plenty of research for the right candidates. The National Comprehensive Cancer Network (NCCN) and American Urological Association guidelines both recommend active surveillance as the preferred option for most men with low-risk prostate cancer.

In fact, in a 15-year randomized trial that compared active monitoring to surgery and radiation, the prostate cancer-specific survival rate was about 97% regardless of whether men were assigned to active monitoring, surgery, or radiotherapy—meaning those who did active monitoring had the same survival rate as those who underwent surgery and/or radiotherapy.

Because those studies show such promising results, uptake of active surveillance is increasing—but it’s still not the universal recommendation quite yet.

5. Overtreatment is expensive for patients and health plans

Even though active surveillance is now a solid recommendation for most low-risk prostate cancer, many men have historically gotten treatment anyway. Alarmingly, one study found that 67% of men with low-risk prostate cancer who had a life expectancy of less than 10 years—because of their age or other health conditions rather than the cancer—were overtreated with surgery or radiation. Their cancer was unlikely to ever cause them problems, meaning the treatment wasn’t truly needed.

In addition to putting patients through invasive treatments (and their side effects) for no real benefit, this also causes a major difference in costs.

The same study estimated that avoiding unnecessary treatment for men with low-grade prostate cancer could save the U.S. up to $1.32 billion a year. A separate oncology study found that shifting low-grade (Gleason 6 or lower) Medicare patients over the age of 70 to active surveillance could save $320 million over three years.

While the potential savings are compelling, quality of life matters just as much—if not more. Unnecessary treatments drive up spending, but they also create otherwise avoidable hassles and potentially long-term side effects for patients who didn’t have anything to gain from treatment.

6. Specialist expertise carries a lot of weight

Where (and from whom) a man gets his diagnosis and treatment recommendations has a big impact on the path he ends up on.

One study found that active surveillance use for low-risk prostate cancer had risen to nearly 60% nationally, up from about 27% in 2014. However, the same study found active surveillance use ranged from 4% to 78% depending on the urology practice, and from 0% to 100% depending on the individual provider within that practice.

It’s proof that, many times, the physician has more influence over the outcome than the diagnosis itself.

A survey of urologists found that more years in practice was associated with lower rates of active surveillance recommendations, along with differences in physician beliefs about treatment effectiveness and assumptions about what patients want. Additionally, urologists were somewhat less likely to recommend active surveillance to Black men.

It’s proof that a lot of diagnoses and treatment decisions depend on clinical judgment. So, employees deserve a second opinion or access to a specialist who’s experienced in active surveillance so they can get care that sticks with guidelines—and helps them skip any unnecessary treatment.

There isn’t just one playbook for prostate cancer. Some prostate cancers will never become a problem, while others need treatment right away. For employers, the difference matters. Unnecessary treatment costs money and causes harm, but under-treatment (or delayed screening) can do the same.

Ultimately, navigating and treating prostate cancer isn’t a choice between more care or less care. It’s about making sure employees get matched to the right care in the form of research-backed screening conversations, access to active surveillance when it’s appropriate, and specialists who don’t default to certain treatments out of habit.

That’s why Carrum Health connects employees with vetted specialists for prostate cancer care. Treatment decisions are guided by evidence and expertise—because when it comes to prostate cancer, the biggest risk to the patient (and the benefits plan) isn’t the diagnosis itself—it’s a mismatch between the disease and the care a person gets for it.