Men with low-grade prostate cancer can opt out of surgery without much risk of death, according to a long-running Johns Hopkins study of 769 men with the disease.

“Active surveillance” may be a better option according to the study, published online in the Journal of Clinical Oncology and thought to be the longest and largest of its kind. 

None of the men, mostly 65 and older, have died since the study began in 1995, though some have had surgery because the cancer spread.

“This study offers the most conclusive evidence to date that active surveillance may be the preferred option for the vast majority of older men diagnosed with a very low-grade or small-volume form of prostate cancer,” Dr. J. Ballentine Carter, study senior investigator and urologist, said in a statement.

Many men still prefer to have the tumor removed, up to 90 percent of the 217,000 American men diagnosed a year, including most 75 and older, said Carter, director of adult urology at the Johns Hopkins Hospital and a professor at the Johns Hopkins University School of Medicine and its Brady Urological Institute.

Carter says the excessive treatment for patients with milder disease needs to be addressed. Complications from surgery or radiation include incontinence and other bowel, urinary or sexual problems.

Carter’s team plans to expand the surveillance study to other institutions. He also hopes to update National Comprehensive Cancer Network guidelines to include surveillance for low-grade cancer. There also are plans for a web-based educational program.