While public health campaigns shine a light on the complex emotional aftermath of prostate cancer in Ireland, new medical data from the United States reveals that an overwhelming majority of veterans with low-risk diagnoses are now bypassing invasive treatments in favor of active surveillance.
Medical practices and public health initiatives are shifting how patients experience and manage prostate cancer, moving away from immediate intervention toward careful monitoring and open conversations about psychological well-being. Two separate developments highlight this dual evolution: a major Irish awareness drive addressing the hidden emotional toll of the disease, and comprehensive new U.S. research demonstrating a massive clinical shift toward active surveillance for low-risk cases.
Marie Keating Foundation Launches Campaign on Emotional Duality
In Ireland, where approximately 4,500 men receive a prostate cancer diagnosis each year, the Marie Keating Foundation has introduced a new awareness initiative called Diagnosis Duality – the Seen, Unseen and Everything in Between
for Blue September. Excluding non-melanoma skin cancer, it remains the most common cancer diagnosed among men in the country.
The initiative explores five distinct emotional pairings that can coexist during and after a diagnosis: Alive / Angry, Free / Fear, Grateful / Grieving, Delighted / Detached, and Strong / Shaken. Public health advocates emphasize that while survival rates have improved substantially over the past three decades—with age-and-stage-standardised five-year net survival rising from 76 per cent for men diagnosed in 1994–1998 to 97 per cent for those diagnosed in 2019–2022, according to the National Cancer Registry Ireland—the psychological aftermath often persists long after clinical treatment concludes.
Forristal noted that patients frequently experience immense relief upon finishing treatment alongside lingering anxiety about the future, anger over side effects like incontinence or early signs of erectile dysfunction, and a general sense of feeling disconnected from their pre-diagnosis selves. The charity’s director of nursing stressed the necessity of making space for honest conversations about mental health, while also urging men to discuss individual risk factors—such as a family history of the disease, inherited genetic factors like BRCA2, or being overweight—and to consult their general practitioners about PSA testing starting at age 50, or age 45 for those with a familial history.
Active Surveillance Becomes the Standard Choice for Low-Risk Cases
Across the Atlantic, clinical practice for managing low-risk disease has undergone a dramatic transformation. Three decades after UC San Francisco pioneered active surveillance for low-risk prostate cancer, a new study published in August reveals that the vast majority of veterans now choose tumor monitoring over immediate surgery or radiation.
Researchers tracking more than 73,000 veterans enrolled in the VA system found that in 2024, 93% of veterans with low-risk prostate cancer underwent active surveillance—consisting of regular PSA blood tests every three to six months, less frequent rectal exams, MRIs, and biopsies—compared to just 27% in 2005. Among patients with favorable intermediate-risk prostate cancer, the rate climbed to 61% in 2024, up sharply from 14% in 2005.
Cooperberg, who also practices at the San Francisco VA Health Care System, noted that many experts are recommending that slow-growing, nonaggressive cells detected during screenings not even be classified as cancers. Active surveillance provides similar long-term survival outcomes to immediate intervention while lowering the risks of bowel problems, urinary incontinence, and erectile dysfunction.
The high uptake of active surveillance within the VA system highlights the importance of integrated healthcare infrastructure in medical decision-making. According to first author Grace Lee, MD, a fifth-year resident physician in the UCSF Department of Urology who practices at the San Francisco VA, surveillance approaches are more likely in the VA system than in outside clinical practices.
The VA is an integrated health care system that has robust practices for tracking quality of care and providing feedback to physicians, and facilitates long-term continuity of patient care, Lee explained
The study was conducted through PROFOUND-VET, a research initiative established within the U.S. Department of Veteran Affairs to develop cancer guidelines. Co-senior authors included Nathanael Fillmore of the VA Boston Healthcare System, Harvard Medical School, and Boston University School of Medicine, alongside co-first author John Bihn of the VA Boston Healthcare System.
Balancing Clinical Precision With Patient Support
While advanced screening and surveillance protocols successfully reduce overtreatment of indolent tumors, the parallel campaigns emphasize that physical preservation does not eliminate psychological challenges. Whether navigating the complexities of monitoring low-risk tumors or managing the invisible emotional residue after completing treatment for aggressive disease, medical professionals and advocacy groups agree that modern prostate cancer care requires addressing both the physical tumor and the patient’s lived reality.
