Current Treatment Options in Oncology

, Volume 14, Issue 1, pp 97–108 | Cite as

Active Surveillance for Prostate Cancer: Overview and Update

Genitourinary Cancer (R Pili, Section Editor)

Opinion statement

Low-risk prostate cancer: How I would treat it?

Overtreatment of many conditions diagnosed by screening has become increasingly recognized as a contemporary malady associated with modern medicine’s efforts at earlier detection. The diagnosis of low-grade prostate cancer clearly qualifies as an example of potential overdiagnosis and overtreatment. Active surveillance for low-risk prostate cancer is an attempt to reduce the overtreatment of the disease. The approach involves initial expectant management rather than immediate therapy. Curative treatment is deferred while the patient is monitored and offered for evidence of risk reclassification to a more aggressive form of the disease. The basis for this approach is substantial evidence confirming the long natural history of most prostate cancers. The objective is to balance the risks of overtreatment and associated adverse quality of life effects, against the risk of progression of disease and a missed opportunity for curative therapy. Low-risk prostate cancer is more accurately viewed as one of several risk factors for the patient harboring higher-grade disease, rather than a life-threatening condition. This approach is similar to that taken historically for so-called precancerous conditions, such as PIN or ASAP, where patients were managed with close follow-up but without radical intervention unless clear evidence of more aggressive disease is identified. Active surveillance is increasingly viewed as the management of choice for patients with very low-risk (low-grade, low-volume prostate cancer) and low-risk (low-grade but higher volume) disease.

Keywords

Prostate cancer Active surveillance Conservative management Low risk cancer Risk reclassification 

Abbreviations

PSA

prostate-specific antigen

ERSPC

European Randomized Trial of Screening for Prostate Cancer

PCPT

Prostate Cancer Prevention Trial

MRI

magnetic resonance imaging

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

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