Active surveillance in intermediate risk prostate cancer.

Area of Science:

• Oncology
• Urology
• Cancer Research

Background:

• Active Surveillance (AS) is a proven option for low-risk prostate cancer (PCa), offering superior functional and oncologic outcomes.
• Extending AS to intermediate-risk PCa is appealing due to its benefits, necessitating a review of current experiences.

Purpose of the Study:

• To review the current experience and status of AS in the intermediate-risk PCa population.
• To evaluate the role of risk stratification and biomarkers in managing intermediate-risk PCa.

Main Methods:

• Systematic review of randomized trials and prospective cohort studies.
• Analysis of clinical factors (age, Gleason 4, PSA density, race/ethnicity, genetics) and genomic markers for prognostic value.

Main Results:

• Predicting the natural history of intermediate-risk PCa remains imperfect.
• AS for all intermediate-risk PCa patients increases metastatic disease rates and reduces cure opportunities.
• A subset of intermediate-risk patients has indolent disease suitable for AS, highlighting heterogeneity not captured by traditional staging.

Conclusions:

• AS is a viable alternative for favorable intermediate-risk PCa but has a modest increased risk of metastasis compared to low-risk disease.
• Biomarkers are essential for enhancing precise risk stratification and patient selection in this subgroup.