Over the last two decades, active surveillance (AS) has been established as a treatment strategy for favorable prostate cancers. This strategy is indicated for insignificant cancer, which is typically indolent with limited potential to progress and will not threaten life prognosis in the future. AS is a practical solution to avoid overtreatment for such insignificant cancer. To avoid missing the signs of disease progression, prostate-specific antigen (PSA) tests, digital rectal examinations, and repeat protocol biopsies have been the mainstay of AS follow-up protocols.