Active surveillance for prostate cancer: current evidence and contemporary state of practice.

Prostate cancer remains one of the most commonly diagnosed malignancies worldwide. Early diagnosis and curative treatment seem to improve survival in men with unfavourable-risk cancers, but significant concerns exist regarding the overdiagnosis and overtreatment of men with lower-risk cancers. To this end, active surveillance (AS) has emerged as a primary management strategy in men with favourable-risk disease, and contemporary data suggest that use of AS has increased worldwide. Although published surveillance cohorts differ by protocol, reported rates of metastatic disease and prostate-cancer-specific mortality are exceedingly low in the intermediate term (5-10 years). Such outcomes seem to be closely associated with programme-specific criteria for selection, monitoring, and intervention, suggesting that AS - like other management strategies - could be individualized based on the level of risk acceptable to patients in light of their personal preferences. Additional data are needed to better establish the risks associated with AS and to identify patient-specific characteristics that could modify prognosis.

Nature reviews. Urology. 2016 Mar 08 [Epub ahead of print]

Jeffrey J Tosoian, H Ballentine Carter, Abbey Lepor, Stacy Loeb

Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, Maryland 21287-2101, USA., Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, Maryland 21287-2101, USA., Department of Urology, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA., Department of Urology, New York University, 550 1st Avenue (VZ30 #612), New York, New York 10016, USA.

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