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Active Surveillance for Intermediate Risk Prostate Cancer

  • Prostate Cancer (S Prasad, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Active surveillance is now widely utilized for the management of low-risk prostate cancer (PCa). The limits of surveillance for men with intermediate risk cancer are controversial. While there is a broad consensus that men with low-risk disease can be safely managed with AS, many potential candidates, including those with Gleason 3 + 4 disease, PSA >10, younger men and African-Americans are often excluded.

Recent Findings

Outcome data for intermediate-risk patients managed by active surveillance demonstrate reasonable outcomes, but these men clearly are at higher risk for progression to metastatic disease. The use of biomarkers and multiparametric MRI will enable a more precise and personalized risk assessment. Literature describing the effects of young age on outcomes is limited, but the experience reported in prospective series with 15–20 year follow-up suggests it is a safe approach. African-American men are at greater risk for occult co-existent higher-grade disease, but in the absence of this their outcome is favorable.

Summary

Patients with intermediate-risk PCa should not be excluded from active surveillance based on a single criterion. Treatment decisions should be based on multiple parameters, including percent Gleason 4, PSA density, cancer volume on biopsy, MRI findings, and patient age and co-morbidity. Genetic tissue-based biomarkers are also likely to play a role in enhancing decision making.

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Authors and Affiliations

  1. Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave. #MG408, Toronto, Ontario, M4N 3M5, Canada

    Laurence Klotz

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  1. Laurence Klotz
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Correspondence to Laurence Klotz.

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Laurence Klotz declares no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Prostate Cancer

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Klotz, L. Active Surveillance for Intermediate Risk Prostate Cancer. Curr Urol Rep 18, 80 (2017). https://doi.org/10.1007/s11934-017-0726-3

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