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Active surveillance for favorable-risk prostate cancer: who, how and why?

Nature Clinical Practice Oncology volume 4, pages 692–698 (2007)Cite this article

Abstract

Active surveillance for favorable-risk prostate cancer has become increasingly common in populations in which screening for prostate cancer is widespread, owing to evidence that in many patients screening results in the detection of disease that is not clinically significant (i.e. untreated, it would not pose a threat to health). The approach is supported by data demonstrating that patients who have clinically insignificant disease can be identified with reasonable accuracy, and that patients who are initially classified as low risk but reclassified over time as higher risk and are treated radically are still cured in most cases. It is important to identify patients who have a low probability of disease progression during their lifetime according to clinical and pathologic features of the disease, patient age and comorbidity. Close monitoring of patients over time and availability of reasonable criteria for intervention, which will both identify more-aggressive disease in a timely fashion and not result in excessive treatment, are crucial. It is also important to communicate appropriately with the patient, to reduce the psychological burden of living with untreated cancer. The results of active surveillance, the criteria for patient selection and the appropriate thresholds for intervention are reviewed in this article.

Key Points

  • Patients with favorable-risk prostate cancer are at low risk of death from cancer

  • Current practice often results in overtreatment

  • Favorable-risk patients can be identified on the basis of the cancer grade, prostate-specific-antigen level, tumor stage and biopsy-volume of cancer

  • A policy of active surveillance with selective, delayed intervention seems to be safe

  • Intervention is warranted for a prostate-specific-antigen doubling time of <3 years or grade progression on repeat biopsy

  • Managing these patients presents a major communication challenge for the health-care team

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Acknowledgements

Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. University of Toronto, Chief, Division of Urology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue #MG408, Toronto, ON M4N 3M5, Canada laurence.klotz@sunnybrook.ca

Authors and Affiliations

  1. L Klotz is Chief of Urology at the Sunnybrook Health Sciences Centre, and Professor of Surgery at the University of Toronto, Toronto, ON, Canada.,

    Laurence Klotz

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Klotz, L. Active surveillance for favorable-risk prostate cancer: who, how and why?. Nat Rev Clin Oncol 4, 692–698 (2007). https://doi.org/10.1038/ncponc0966

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