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Active Surveillance Preserves Sexual and Urinary Function in Low-Risk Prostate Cancer

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Quality of life in low-risk prostate cancer under active surveillance or following radical treatments the START cohort study.DOI 10.1038s41391-025-01032-0

Many men diagnosed with low-risk prostate cancer face an important decision. They can choose immediate treatment, like surgery or radiation, or follow active surveillance, where doctors closely monitor the cancer and treat it only if it begins to grow.

A large real-world study from Italy followed more than 650 men with low-risk prostate cancer to understand how these choices affect quality of life. Patients selected one of three options: active surveillance, radical prostatectomy (surgery), or radiotherapy.

Researchers tracked patient-reported outcomes for almost three years, including general quality of life, mental health, sexual function, and urinary symptoms.
The results showed that overall quality of life and mental health were similar whether patients chose monitoring or surgery. This means many men felt emotionally and physically stable regardless of the treatment path.

Important differences appeared in daily functioning. Men on active surveillance maintained better sexual function and physical activity levels than those who underwent surgery. They also had a much lower need for incontinence aids, meaning better bladder control.
Surgery did help reduce certain urinary blockage symptoms caused by the prostate. These symptoms remained stable in men who chose active surveillance.

The study shows that active surveillance can help preserve sexual health and urinary control without harming overall quality of life in men with low-risk prostate cancer. For many patients, careful monitoring may be a safe option that avoids the side effects of immediate treatment.

These findings can help men and their doctors choose the treatment approach that best fits their priorities and lifestyle.

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