Active surveillance for low-risk localized prostate cancer

Abstract

The management of localized prostate cancer in an otherwise healthy male is complex, evolving, and largely consists of three modalities: surgery, radiation, and active surveillance. In this review, we summarize contemporary data pertaining to active surveillance, a strategy in which patients with low-risk cancer characteristics undergo monitoring at regular intervals. Treatment is initiated following evidence of cancer features associated with a higher risk of progression. Multiple clinical experiences suggest active surveillance is a safe and appropriate strategy for select patients. Most definitions of low-risk cancer include a variable combination of: prostate-specific antigen (PSA) < or =10 ng/mL, clinical stage T1-T2a, biopsy Gleason score < or =6, and three or fewer positive biopsy cores. Although older patients or those with signficant competing medical risks typically are not treated with surgery or radiation, active surveillance should also be considered and explained to well-selected healthy patients otherwise considering primary therapy. Due to significant concerns about clinical understaging, eligible patients should consider a repeat biopsy prior to selecting active surveillance. Short- to intermediate-term follow-up suggests active surveillance is associated with favorable overall outcomes, including for those undergoing delayed treatment, and has a relatively low risk of leading to incurable prostate cancer.