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Prostate Cancer

I've been diagnosed with prostate cancer. Can it be watched instead of treated?

For about a quarter of Korean patients, yes — and that is the ceiling, not the average. Which quarter you are in depends on the biopsy, not on preference.

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Answer

Active surveillance is an option for roughly a quarter of Korean patients: among 27,075 men with biopsy-confirmed prostate cancer across 51 Korean hospitals, 6,586 (24.3 percent) were eligible under a deliberately maximised definition counting low risk, potentially low risk and favourable intermediate risk together — eligibility that fell from 27.6 percent in 2010 to 22.0 percent in 2020, and that ranged from 16.9 percent in Chungbuk to 29.3 percent in Gyeonggi — while under the narrower low-risk-only definition the figure is 5.45 percent.

Key takeaways

  • Among 27,075 Korean men with biopsy-confirmed prostate cancer, 24.3 percent were eligible for active surveillance under a maximised definition.
  • Under the narrower low-risk-only definition the eligible share is 5.45 percent, with another 4.00 percent potentially low risk.
  • The risk distribution was 5.45 percent low, 4.00 percent potentially low, 14.88 percent favourable intermediate, 21.72 percent unfavourable intermediate and 53.94 percent high risk.
  • Eligibility fell from 27.6 percent in 2010 to 22.0 percent in 2020 (p < 0.001).
  • Across 17 administrative districts eligibility ranged from 16.9 percent to 29.3 percent (p < 0.001).
  • Urban areas had higher eligibility than rural ones, at 26.4 against 20.5 percent.
  • Eligibility is calculated from PSA, clinical stage, Gleason grade group and biopsy core involvement — features of the tumour, not of the patient's wishes.

Active surveillance means being monitored with PSA tests, examinations and repeat biopsies rather than being treated, with treatment held in reserve if the cancer changes. Whether it is available to you is decided by what the biopsy showed, and Korean national data now says how often that answer is yes.

24.3%

of 27,075 Korean men with newly diagnosed prostate cancer were eligible for active surveillance under a maximised definitionKo YH et al., Prostate International, 2026

Why 24.3 percent is a ceiling

The researchers deliberately drew the definition as wide as the evidence allows, counting favourable intermediate-risk disease as eligible alongside low and potentially low risk. Under the narrower definition most guidelines used historically — low risk alone — the figure would be 5.45 percent.

That matters when you are given the number. One in four is the most generous reading of who could be watched, not the typical case. More than half of Korean prostate cancer, 53.94 percent, is high risk at diagnosis, and surveillance is not an option for it.

The trend is going the wrong way

Eligibility fell from 27.6 percent in 2010 to 22.0 percent in 2020. In a decade when testing became more available, not less, you would expect the opposite: more testing usually finds more small, slow cancers, which means more men who can be watched. Korea moved the other way, which points at detection happening later rather than earlier.

What to ask

The useful questions are specific: what is my Gleason grade group, what is my clinical stage, what proportion of the biopsy cores were involved, and does that put me in the low, favourable intermediate, or higher risk category. Those four answers determine whether surveillance is on the table, and they are all already in your pathology report.

One structural caveat on the data: the cohort covers 37.9 percent of nationally reported cases, abstracted from hospitals with 200 or more beds, so it is a large sample rather than a complete census.

Sources

  1. 1

    Ko YH, Kim SW, Son NH

    Active surveillance could apply to one-quarter of Korean prostate cancer cases: Insights from a 27,075-patient cohort

    Prostate International 2026;14(2):127-131

    doi:10.1016/j.prnil.2025.12.004 · PMID:42382553

    https://doi.org/10.1016/j.prnil.2025.12.004
  2. 2

    Ko YH, Kim SW, Son NH

    Incidence of High-Risk Prostate Cancer in Korea: Insights From Real-World Data Between 2010 and 2020

    Journal of Korean Medical Science 2026;41(14):e10

    doi:10.3346/jkms.2026.41.e10 · PMID:41978922

    https://doi.org/10.3346/jkms.2026.41.e10