Active surveillance for men with low-risk, clinically localized prostate cancer
- Laurence Klotz, MD
Laurence Klotz, MD
- Professor of Surgery
- University of Toronto
- Sunnybrook Health Sciences Centre
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
INTRODUCTION AND DEFINITION OF TERMS
Active surveillance for men with prostate cancer involves the avoidance or postponement of immediate therapy combined with careful surveillance; definitive treatment is then offered if there is evidence that the patient is at increased risk for disease progression. Active surveillance is the preferred option for the initial management of most men with localized low-risk prostate cancer [1,2].
Active surveillance differs from watchful waiting (observation), which is based upon the premise that men will not benefit from definitive treatment of clinically localized prostate cancer because of limited life expectancy, comorbidity, and the prolonged natural history of the prostate cancer . For patients managed with watchful waiting, the decision is made at the outset to forego definitive treatment and to provide systemic or local treatment to palliate symptoms if disease progresses locally or at distant metastatic sites.
Key aspects of active surveillance for patients with localized low-risk prostate cancer will be reviewed here, including:
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- INTRODUCTION AND DEFINITION OF TERMS
- PATIENT SELECTION
- Guideline recommendations
- Guideline criteria
- Other parameters
- SURVEILLANCE STRATEGY
- Serum PSA
- Digital rectal examination
- Prostate biopsy
- Prevention of progression
- Observational studies
- Randomized trials
- Quality of life
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS