There are multiple management options for men with grade group 1 (GG 1) prostate cancer (PCa). According to the National Comprehensive Care Network, European Association of Urology, and American Urological Association (AUA) guidelines, active surveillance (AS) is the preferred strategy for patients with low-risk PCa (LRPCa) [1], [2], [3], [4]. Long-term outcomes of AS have been associated with a minimal risk of metastasis or death from PCa [5], [6], [7].

Despite the indolent nature of GG 1 PCa [8], [9], [10], a significant proportion of patients with low-risk disease still undergo radical therapy, including 50% in the USA [11], with one-third of these cases receiving treatment despite no objective evidence of grade progression [12], [13]. This highlights a disconnect between everyday practice and the established standard of care. It also raises concerns regarding appropriate patient counseling, a potential bias towards overtreatment, and opportunities to improve shared decision-making between clinicians and their patients. Our hypothesis is that GG 1 PCa is overtreated because of common misconceptions regarding outcomes for men with this diagnosis.

We conducted an international survey to evaluate the perception of and management for patients with LRPCa (defined as Gleason score 6, prostate-specific antigen [PSA] <10 ng/dl, and clinical stage T1–2a) and very low-risk PCa (VLRPCa; PSA density <0.15 ng/ml/ml, <34% of biopsy cores involved) among physicians from multiple specialties (urology, radiation oncology, medical oncology, and pathology). We also queried opinions regarding AS outcomes and potential renaming of GG 1 disease to reflect its indolence.