Why bother with AS? If a g6 is incapable of spreading outside the capsule and cannot metastasize to lymph nodes or anywhere else and does not progress to a higher grade, why bother even with AS or anything else. I have read in this thread about all of these studies that show no g6 has ever spread anywhere. If these doctors are so certain of their test results and others' research, why don't they tell their patients to pull up their pants and go home? If a g6 is as harmless as these doctors claim, they should not preach AS and charge men for years of AS for a cancer they claim cannot spread anywhere.
In fact, what you suggest is the current trend. Many institutions are questioning whether their AS protocols are too rigorous and place too great a burden on the patient. Johns Hopkins, for example, which has one of the most stringent AS protocols -- only very low risk and annual biopsies -- is in the process of relaxing those standards:Expanded Criteria to Identify Men Eligible for Active Surveillance of Low Risk Prostate Cancer at Johns Hopkins
NCCN includes AS as an acceptable option for all
low risk men, and some question whether that ought to be expanded to include favorable intermediate risk men as well. Some institutions are following a pattern of progressively longer periods between biopsies.
The hard part will always be identifying a true GS6. about
a quarter of GS6 will upgrade at prostatectomy (about
90% to GS3+4, often of indolent type). Developments in improved image-guided biopsies will make that determination more reliable. Already mpMRIs can rule out higher grade cancers with about
96+% reliability. Also, progression to higher grade may occur over time at an estimated rate of about
1% per year, so some kind of vigilance may always be necessary.
AS protocol development is evolving, with fine-tuning occurring all the time (Just as radiation and surgical protocols are evolving). I agree that current protocols are probably over-intrusive, but they err on the side of caution. As more studies like this emerge, and as we refine the best indicators of progression, I expect protocols will change.