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Active surveillance for low-risk prostate cancer: an update

Nature Reviews Urology volume 8, pages 312–320 (2011)Cite this article

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Abstract

Active surveillance is now an accepted management strategy for men with low-risk localized prostate cancer, in recognition of the knowledge that the majority of men with such cancers are likely to die from other causes. The most obvious benefit of active surveillance is the reduction of morbidity associated with surgery by delaying or avoiding radical gland therapy. Other advantages include lower overall costs to the health-care system and potentially a better quality of life. These advantages should be balanced against the risks of delayed therapy, the most considerable of which being development of more-aggressive disease. Appropriate selection criteria and the definition of triggers for intervention with radical therapy are critical components of an active surveillance protocol. The ability to accurately identify and cure the men whose cancers will progress using clinical, biopsy and imaging data is yet to be resolved, as is the psychological burden of living with an untreated cancer. The benefit of 5α-reductase inhibitors as secondary chemoprevention in men on active surveillance is a new avenue of research. Focal therapy, which has the similar aim of reducing morbidity while maintaining oncological control, is an emerging competitor for active surveillance. Nevertheless, active surveillance is an appealing management option for selected men with prostate cancer.

Key Points

  • Active surveillance is now an accepted management strategy for men with low-risk localized prostate cancer, in recognition of the fact that most men with such cancers will die from other causes

  • Benefits of active surveillance include the preservation of erectile function and continence, which remain a concern in men treated radically from the outset

  • The largest risk associated with active surveillance is the development of more-aggressive disease and the ultimate need for adjuvant treatment as well as radical intervention

  • Appropriate patient selection criteria and triggers for radical intervention are critical components of an active surveillance protocol

  • The ability to accurately identify and cure the men whose cancers will progress using clinical, biopsy and imaging data is yet to be resolved

  • The role of 5α-reductase inhibitors and focal therapy for men on active surveillance are new avenues of research

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Authors and Affiliations

  1. Ludwig Institute for Cancer Research and University of Melbourne Department of Surgery, Austin Hospital, Studley Road, Melbourne, 3084, Vic, Australia

    Nathan Lawrentschuk

  2. Department of Surgery, Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room MG 204, Toronto, M4N 3M5, ON, Canada

    Laurence Klotz

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  1. Nathan Lawrentschuk
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N. Lawrentschuk and L. Klotz contributed equally to researching data for the article, discussion of content and editing the manuscript before submission. N. Lawrentschuk wrote the article.

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Correspondence to Nathan Lawrentschuk.

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Lawrentschuk, N., Klotz, L. Active surveillance for low-risk prostate cancer: an update. Nat Rev Urol 8, 312–320 (2011). https://doi.org/10.1038/nrurol.2011.50

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