Defining 'progression' and triggers for curative intervention during active surveillance

Area of Science:

• Oncology
• Urology

Background:

• Many low-risk prostate cancers lack metastatic potential and do not threaten lifespan.
• Recent evidence clarifies patient selection for conservative management.

Purpose of the Study:

• To review evidence supporting conservative management for low-risk prostate cancer.
• To highlight the role of active surveillance in managing these cancers.

Main Methods:

• Review of recent scientific evidence on prostate cancer management.
• Analysis of outcomes associated with active surveillance protocols.

Main Results:

• Conservative management, including active surveillance, is suitable for many low-risk prostate cancer patients.
• Active surveillance shows a 5% cancer-specific mortality at 15 years, with selective intervention for disease progression.
• Approximately 30% of newly diagnosed low-risk patients may harbor higher-risk disease requiring definitive therapy.

Conclusions:

• Active surveillance is well-tolerated for low-risk prostate cancer in the intermediate-to-long term.
• Ongoing refinements include MRI, targeted biopsies, and biomarkers to optimize patient selection and intervention triggers.