Background: Active surveillance (AS) represents an expectant treatment strategy for clinically localized prostate cancer (PCa) with low-risk features. Objective: The actual management as well as the pros and cons of AS were evaluated. Methods: A systematic review of the recent literature was performed using the Medline databases. Conclusions: Since a substantial number of men die with rather than from PCa, there is a considerable role for AS in carefully selected men. AS may also represent a strategy to reduce the burden of overtreatment rooted in intensified PSA testing. Facing the imprecision of risk stratification based on transrectal ultrasound-guided biopsy, accurate clinical staging represents a major medical challenge. Counseling and care require empathy as well as a profound understanding of the biology and the natural history of PCa.

Keywords:
Active surveillance, Prostate cancer
1.
Siegel R, Naishadham D, Jemal A: Cancer statistics, 2013. CA Cancer J Clin 2013;63:11-30.
2.
Zlotta AR, Egawa S, Pushkar D, Govorov A, Kimura T, Kido M, et al: Prevalence of prostate cancer on autopsy: cross-sectional study on unscreened Caucasian and Asian men. J Natl Cancer Inst 2013;105:1050-1058.
3.
Franks LM: Latent carcinoma of the prostate. J Pathol Bacteriol 1954;68:603-616.
4.
National Cancer Institute: Lifetime risk (percent) of being diagnosed with cancer by site and race/ethnicity: males, 18 SEER areas, 2008-2010. SEER Cancer Statistics Review 1975-2010, table 1.16, 2013. http://seer.cancer.gov/archive/csr/1975_2010/results_merged/topic_lifetime_risk_diagnosis.pdf.
5.
National Cancer Institute: Lifetime risk (percent) of dying from cancer by site and race/ethnicity: males, total U.S., 2008-2010. SEER Cancer Statistics Review 1975-2010, table 1.19, 2013. http://seer.cancer.gov/archive/csr/1975_2010/results_merged/topic_lifetime_risk_death.pdf.
6.
Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al: Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012;366:981-990.
7.
Draisma G, Etzioni R, Tsodikov A, Mariotto A, Wever E, Gulati R, et al: Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst 2009;101:374-383.
8.
Wu GH, Auvinen A, Yen AM, Hakama M, Walter SD, Chen HH: A stochastic model for survival of early prostate cancer with adjustments for leadtime, length bias, and over-detection. Biom J 2012;54:20-44.
9.
Vickers AJ, Sjoberg DD, Ulmert D, Vertosick E, Roobol MJ, Thompson I, et al: Empirical estimates of prostate cancer overdiagnosis by age and prostate-specific antigen. BMC Med 2014;12:26.
10.
Kim S 2nd, Dall'Era MA, Evans CP: Economic analysis of active surveillance for localized prostate cancer. Curr Opin Urol 2012;22:247-253.
11.
World Health Organization: Life expectancy - data by country 2014. http://apps.who.int/gho/data/node.main.688?lang=en.
12.
Schostak M, Baumunk D, Jagota A, Klopf C, Winter A, Schafers S, et al: Time trends in prostate cancer surgery: data from an Internet-based multicentre database. BJU Int 2012;109:355-359.
13.
Hayes JH, Ollendorf DA, Pearson SD, Barry MJ, Kantoff PW, Stewart ST, et al: Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis. JAMA 2010;304:2373-2380.
14.
Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, et al: Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med 2014;370:932-942.
15.
Wilt TJ: SPCG-4: a needed START to PIVOTal data to promote and protect evidence-based prostate cancer care. J Natl Cancer Inst 2008;100:1123-1125.
16.
Vickers A, Bennette C, Steineck G, Adami HO, Johansson JE, Bill-Axelson A, et al: Individualized estimation of the benefit of radical prostatectomy from the Scandinavian Prostate Cancer Group randomized trial. Eur Urol 2012;62:204-209.
17.
Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al: Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012;367:203-213.
18.
Epstein JI, Walsh PC, Carmichael M, Brendler CB: Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994;271:368-374.
19.
Bastian PJ, Mangold LA, Epstein JI, Partin AW: Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer 2004;101:2001-2005.
20.
D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998;280:969-974.
21.
Bul M, Zhu X, Valdagni R, Pickles T, Kakehi Y, Rannikko A, et al: Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol 2013;63:597-603.
23.
Tosoian JJ, Trock BJ, Landis P, Feng Z, Epstein JI, Partin AW, et al: Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 2011;29:2185-2190.
24.
van As NJ, Norman AR, Thomas K, Khoo VS, Thompson A, Huddart RA, et al: Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance. Eur Urol 2008;54:1297-1305.
25.
Vellekoop A, Loeb S, Folkvaljon Y, Stattin P: Population based study of predictors of adverse pathology among candidates for active surveillance with Gleason 6 prostate cancer. J Urol 2014;191:350-357.
26.
Conti SL, Dall'era M, Fradet V, Cowan JE, Simko J, Carroll PR: Pathological outcomes of candidates for active surveillance of prostate cancer. J Urol 2009;181:1628-1633; discussion 1633-1634.
27.
Palisaar JR, Noldus J, Loppenberg B, von Bodman C, Sommerer F, Eggert T: Comprehensive report on prostate cancer misclassification by 16 currently used low-risk and active surveillance criteria. BJU Int 2012;110 (6 Pt B):E172-E181.
28.
Kuroiwa K, Shiraishi T, Naito S: Gleason score correlation between biopsy and prostatectomy specimens and prediction of high-grade Gleason patterns: significance of central pathologic review. Urology 2011;77:407-411.
29.
Helpap B, Kristiansen G, Kollermann J, Shaikhibrahim Z, Wernert N, Oehler U, et al: Significance of Gleason grading of low-grade carcinoma of the prostate with therapeutic option of active surveillance. Urol Int 2013;90:17-23.
30.
Motamedinia P, Richard JL, McKiernan JM, DeCastro GJ, Benson MC: Role of immediate confirmatory prostate biopsy to ensure accurate eligibility for active surveillance. Urology 2012;80:1070-1074.
31.
Barzell WE, Melamed MR, Cathcart P, Moore CM, Ahmed HU, Emberton M: Identifying candidates for active surveillance: an evaluation of the repeat biopsy strategy for men with favorable risk prostate cancer. J Urol 2012;188:762-767.
32.
Umbehr MH, Largo RA, Gfeller S, Tremp M, Poyet C, Paul M, et al: Bilaterally positive biopsy cores are associated with non-organ-confined disease in prostate cancer patients eligible for active surveillance. Urol Int 2014;93:176-181.
33.
Iremashvili V, Pelaez L, Manoharan M, Jorda M, Rosenberg DL, Soloway MS: Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols. Eur Urol 2012;62:462-468.
34.
McVey GP, McPhail S, Fowler S, McIntosh G, Gillatt D, Parker CC: Initial management of low-risk localized prostate cancer in the UK: analysis of the British Association of Urological Surgeons Cancer Registry. BJU Int 2010;106:1161-1164.
35.
Albertsen PC, Hanley JA, Gleason DF, Barry MJ: Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 1998;280:975-980.
36.
Soloway MS, Soloway CT, Eldefrawy A, Acosta K, Kava B, Manoharan M: Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. Eur Urol 2010;58:831-835.
37.
Adamy A, Yee DS, Matsushita K, Maschino A, Cronin A, Vickers A, et al: Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer. J Urol 2011;185:477-482.
38.
Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A: Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 2010;28:126-131.
39.
Ross AE, Loeb S, Landis P, Partin AW, Epstein JI, Kettermann A, et al: Prostate-specific antigen kinetics during follow-up are an unreliable trigger for intervention in a prostate cancer surveillance program. J Clin Oncol 2010;28:2810-2816.
40.
Cooperberg MR, Cowan JE, Hilton JF, Reese AC, Zaid HB, Porten SP, et al: Outcomes of active surveillance for men with intermediate-risk prostate cancer. J Clin Oncol 2011;29:228-234.
41.
Park HJ, Ha YS, Park SY, Kim YT, Lee TY, Kim JH, et al: Incidence of upgrading and upstaging in patients with low-volume Gleason score 3+4 prostate cancers at biopsy: finding a new group eligible for active surveillance. Urol Int 2013;90:301-305.
42.
Bul M, Zhu X, Rannikko A, Staerman F, Valdagni R, Pickles T, et al: Radical prostatectomy for low-risk prostate cancer following initial active surveillance: results from a prospective observational study. Eur Urol 2012;62:195-200.
43.
Dall'Era MA, Cowan JE, Simko J, Shinohara K, Davies B, Konety BR, et al: Surgical management after active surveillance for low-risk prostate cancer: pathological outcomes compared with men undergoing immediate treatment. BJU Int 2011;107:1232-1237.
44.
van den Bergh RC, Steyerberg EW, Khatami A, Aus G, Pihl CG, Wolters T, et al: Is delayed radical prostatectomy in men with low-risk screen-detected prostate cancer associated with a higher risk of unfavorable outcomes? Cancer 2010;116:1281-1290.
45.
Xia J, Trock BJ, Cooperberg MR, Gulati R, Zeliadt SB, Gore JL, et al: Prostate cancer mortality following active surveillance versus immediate radical prostatectomy. Clin Cancer Res 2012;18:5471-5478.
46.
Palgi Y, Shmotkin D: The predicament of time near the end of life: time perspective trajectories of life satisfaction among the old-old. Aging Ment Health 2010;14:577-586.
47.
van den Bergh RC, Essink-Bot ML, Roobol MJ, Wolters T, Schroder FH, Bangma CH, et al: Anxiety and distress during active surveillance for early prostate cancer. Cancer 2009;115:3868-3878.
48.
Bellardita L, Rancati T, Alvisi MF, Villani D, Magnani T, Marenghi C, et al: Predictors of health-related quality of life and adjustment to prostate cancer during active surveillance. Eur Urol 2013;64:30-36.
49.
Johansson E, Bill-Axelson A, Holmberg L, Onelov E, Johansson JE, Steineck G: Time, symptom burden, androgen deprivation, and self-assessed quality of life after radical prostatectomy or watchful waiting: the Randomized Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) clinical trial. Eur Urol 2009;55:422-430.
50.
Aizer AA, Paly JJ, Zietman AL, Nguyen PL, Beard CJ, Rao SK, et al: Multidisciplinary care and pursuit of active surveillance in low-risk prostate cancer. J Clin Oncol 2012;30:3071-3076.
51.
Okihara K, Mikami K, Kamoi K, Kitamura K, Kawauchi A, Miki T: Assessment of screenees' knowledge on prostate cancer: results of a questionnaire using the Fact Sheet. Urol Int 2013;91:49-54.
52.
Lin DW, Newcomb LF, Brown EC, Brooks JD, Carroll PR, Feng Z, et al: Urinary TMPRSS2:ERG and PCA3 in an active surveillance cohort: results from a baseline analysis in the Canary Prostate Active Surveillance Study. Clin Cancer Res 2013;19:2442-2450.
53.
Tosoian JJ, Loeb S, Kettermann A, Landis P, Elliot DJ, Epstein JI, et al: Accuracy of PCA3 measurement in predicting short-term biopsy progression in an active surveillance program. J Urol 2010;183:534-538.
54.
Augustin H, Mayrhofer K, Pummer K, Mannweiler S: Relationship between prostate cancer gene 3 (PCA3) and characteristics of tumor aggressiveness. Prostate 2013;73:203-210.
55.
Tosoian JJ, Loeb S, Feng Z, Isharwal S, Landis P, Elliot DJ, et al: Association of [-2]proPSA with biopsy reclassification during active surveillance for prostate cancer. J Urol 2012;188:1131-1136.
56.
Turkbey B, Mani H, Aras O, Ho J, Hoang A, Rastinehad AR, et al: Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology 2013;268:144-152.
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