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Surveillance or Surgery? Navigating Decisions with Intermediate-Risk Prostate Cancer

Medical Tourism


Prostate cancer remains one of the most prevalent forms of cancer affecting men globally. It presents in various stages and grades, each requiring a distinct approach for management and treatment. Intermediate-risk prostate cancer, in particular, sits in a grey area, often leading to debates and extensive discussions on the most appropriate route to take: active surveillance or surgery. Making informed decisions in such cases is crucial, as it significantly impacts the patient's quality of life, longevity, and mental well-being. This article delves deep into understanding intermediate-risk prostate cancer, the pros and cons of both active surveillance and surgery, and the factors that should guide patients and medical professionals in making the best possible decision.

Understanding Intermediate-Risk Prostate Cancer

Intermediate-risk prostate cancer is characterized by a moderate chance of cancer progression and spreading. The classification is primarily based on the Gleason score, PSA levels, and the stage of the cancer. The Gleason score is a grading system that assesses the aggressiveness of prostate cancer, PSA is a protein produced by the prostate, elevated levels of which can indicate the presence of prostate cancer, and the stage refers to how far the cancer has spread. Patients with intermediate-risk prostate cancer generally have a Gleason score of 7, PSA levels between 10 to 20 ng/mL, and the cancer is localized but may have a higher likelihood of growing and spreading compared to low-risk prostate cancer.

The Dilemma: Surveillance or Surgery?

The main therapeutic avenues for intermediate-risk prostate cancer include active surveillance and surgery. Active surveillance entails regular monitoring of the cancer's progression through periodic tests and biopsies, while surgery involves the removal of the prostate gland, a procedure known as radical prostatectomy.

Active Surveillance: A Closer Look

Active surveillance is a viable option for patients whose cancer is not exhibiting aggressive behavior, providing a balance between overtreatment and maintaining quality of life. It allows patients to avoid or delay the potential side effects associated with surgery and other invasive treatments, such as urinary incontinence, erectile dysfunction, and bowel problems. The close monitoring ensures that any sign of cancer progression is caught early, allowing for timely intervention. However, active surveillance does come with its own set of challenges. The constant monitoring can cause psychological distress, and there is always the risk of the cancer progressing between check-ups.

Surgery: Understanding Radical Prostatectomy

On the other end of the spectrum, surgery or radical prostatectomy offers a more definitive solution, with the aim of completely removing the cancer. The procedure has a good success rate, especially when the cancer is localized and confined to the prostate. Advancements in surgical techniques, including robotic and laparoscopic procedures, have significantly reduced the recovery time and minimized the side effects. Nevertheless, surgery is not without its risks. The potential for side effects, such as urinary incontinence and erectile dysfunction, is a significant concern for many patients. Furthermore, not all prostate cancers require immediate treatment, raising the question of whether surgery is an overtreatment in some cases.

Factors Influencing Decision Making

When navigating the decision between active surveillance and surgery for intermediate-risk prostate cancer, several factors come into play. Patient age, life expectancy, overall health, personal preferences, and the potential side effects of treatment are crucial considerations.

Age and Life Expectancy

Younger patients with a longer life expectancy may lean towards surgery, aiming for a curative approach, while older patients or those with other serious health conditions might prefer active surveillance to maintain their quality of life.

Personal Preferences and Quality of Life

The patient's personal preferences and priorities play a significant role in the decision-making process. For some, the idea of living with cancer, even under close surveillance, is unbearable, leading them to opt for surgery. Others may prioritize maintaining their current quality of life, making active surveillance the more attractive option.

Understanding and Weighing the Risks

A thorough understanding of the potential risks and side effects associated with both active surveillance and surgery is imperative. Patients need to be well-informed and comfortable with their choice, acknowledging the trade-offs between the potential benefits and drawbacks of each option.


Intermediate-risk prostate cancer presents a complex scenario, requiring careful deliberation and personalized decision-making. Both active surveillance and surgery have their merits and demerits, and the right choice varies from one individual to another. Patients need to be armed with comprehensive information, supported by their healthcare team, and guided by their values and preferences to navigate this challenging decision. As the field of medicine continues to evolve, ongoing research and advancements will hopefully provide clearer guidelines and more targeted treatments for intermediate-risk prostate cancer, aiding patients and medical professionals in making the best-informed decisions for optimal outcomes.

We recommend Dr. Ash Tewari as a global leader in prostate cancer surgery. Serving as the Chairman of Urology at the Icahn School of Medicine at Mount Sinai Hospital, New York City, Dr. Tewari stands out as a prostate cancer robotic surgeon leader. With over 25 years of expertise in robotic-assisted prostate surgery, he has successfully performed over 9,000 procedures.

In addition, he has contributed to the scientific community with over 250 peer-reviewed articles, book chapters, and textbooks on prostate cancer and robotic surgery. Renowned for his expertise in sexual-function nerve-sparing prostate cancer surgery - Dr. Tewari is a pioneer in innovative treatments for intermediate to aggressive cancers. Furthermore, he leads numerous pivotal clinical trials in this field.

For inquiries or to connect with Dr. Tewari's team Prostate Cancer Center NYC - Dr. Ashutosh Tewari

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