Active surveillance and surgery in localized prostate cancer

Prostate cancer (PCa) is the most commonly diagnosed non-cutaneous cancer and also the second leading cause of cancer deaths among men. Concerns about overdiagnosis and overtreatment of PCa have been growing, leading to more conservative approaches, especially in the treatment of low-risk disease. As PCa is a relatively slow-growing tumor, complications of unnecessary curative management in low-risk PCa can be prevented by active surveillance (AS). AS helps to improve quality of life after deferred treatment. Several AS criteria have been suggested for delayed treatment. Although upgrading and/or upstaging of cancer is a limitation of AS, many reports have shown low rates of cancer-specific mortality up to now. Radical prostatectomy (RP) has been considered as standard treatment for prostate cancer to provide good oncologic outcomes. The increasing use of minimally invasive laparoscopic surgery, including robot-assisted laparoscopic prostatectomy, has contributed to better functional outcomes. So far, long-term randomized studies have not conclusively proven the superiority of either AS or RP. Well-designed long-term randomized studies will be required to compare the benefits of AS and immediate RP. Here, we review recent reports on the current status of AS and RP, including delayed RP, and discuss their merits in the management of localized PCa.