Sunnybrook Health Sciences Centre Toronto, ON, Canada.
Active surveillance for Active surveillance (AS), since first being described in 2002 is now an accepted treatment strategy for men with low risk CaP where previously they faced radical whole gland treatment (surgery, external-beam radiation or brachytherapy). AS has built upon the experience of watchful waiting in men believed to not require radical treatment given their age or co-morbidities that were both felt to compete with the risk of death from their CaP. AS and radical treatments both have merits and disadvantages. AS has minimal morbidity but the inherent risk of progression associated with expectant management. Radical therapies have an impact on erectile function and continence but provide definitive treatment. Between AS and radical treatment lies focal therapy. Although appearing safe, focal therapy has been limited to small cohorts with short follow-up and cannot be recommended outside study protocols. Most men and their physicians with favorable risk CaP choose between AS and radical therapy. In this review we will focus upon the rationale, patient selection, method of follow-up, triggers for intervention, and the published experience with men undergoing AS with low-risk CaP. We propose a complementary role for surveillance and focal therapy.
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Reference: Minerva Urol Nefrol. 2011 Jun;63(2):145-53.