[Pros and cons of active surveillance for low-risk prostate cancer]

Because of the recent increase of prostate specific antigen (PSA)-screening, potential risks of overdiagnosis and overtreatment are more easily pointed out for low-risk prostate cancer. Active surveillance is one of the therapeutic options for the management of patients with low-risk prostate cancer. Concerning the indication of active surveillance, candidates for it have been selected based on several clinical factors including clinical stage(T), PSA level, Gleason score, and the number of positive cores on prostatic biopsy, but the selection criteria have not yet been uniformly established. As for the observation method, PSA doubling time and results from repeated biopsies have been utilized to select a high-risk case for whom intervention by curative therapy will be recommended. However, there are still controversies concerned with which is the most appropriate method of follow-up during active surveillance. In addition, the psychological impact of active surveillance on both the patient and the health care staff needs to be taken into account. Since the efficacy and safety of active surveillance were demonstrated by the results of several clinical studies, it is regarded as one of the superior and acceptable therapeutic options for patients with low-risk prostate cancer. It is expected that both the patient and health care staff would choose active surveillance as a reliable option when the appropriate selection criteria and the suitable follow-up method are determined and established.