Long-term evidence shows that monitoring localized prostate cancer is a safe alternative to immediate surgery or radiation, according to researchers. The results, published in the New England Journal of Medicine and presented at a European Association of Urology conference in Milan, are encouraging for men who want to avoid treatment-related sexual and incontinence problems. The study directly compared surgery, radiation and monitoring. Most prostate cancers grow slowly, so it takes many years to look at the disease’s outcomes. Researchers followed more than 1,600 UK men who agreed to be randomly assigned to get surgery, radiation or active monitoring. At 15 years, cancer had spread in 9.4% of the active-monitoring group, 4.7% of the surgery group and 5% of the radiation group. The study was started in 1999, and experts said today’s monitoring practices are better, with MRI imaging and gene tests guiding decisions.