Advertisement

EDITORIAL COMMENT

      Long-term outcomes of active surveillance (AS) for selected patient cohorts, as well as controlled trials randomizing men with localized prostate cancer (CaP) for treatment confirm the very favorable disease-specific outcomes when low-risk CaP is initially managed expectantly.
      • Klotz Vesprini
      • Sethukavalan
      • et al.
      Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.
      • Hamdy Donovan
      • Lane
      • et al.
      10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer.
      • Wilt Vo
      • Langsetmo L
      • et al.
      Radical prostatectomy or observation for clinically localized prostate cancer: extended follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT).
      Risk stratification has since then improved due to application of nomograms, MRI, and extended (targeted) biopsy protocols, further reducing the likelihood of undergrading significant disease. The eligibility for AS is based on different tumor (eg, stage, PSA, density, MRI, Gleason score, and other biopsy details) and patient (eg, family history, LUTS, anxiety and stress levels) characteristics.
      • Mottet N
      • van den Bergh RCN
      • Briers E
      • et al.
      EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent.
      However, the attitude of involved healthcare professionals towards expectant management has a major, often decisive, impact in the shared-decision making process. Reasons for not recommending AS may include lack of confidence in the favorable outcome, but also financial or logistic considerations.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Klotz Vesprini
        • Sethukavalan
        • et al.
        Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.
        J Clin Oncol. 2015; 33: 272-277
        • Hamdy Donovan
        • Lane
        • et al.
        10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer.
        N Engl J Med. 2016; 375: 1415-1424
        • Wilt Vo
        • Langsetmo L
        • et al.
        Radical prostatectomy or observation for clinically localized prostate cancer: extended follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT).
        Eur Urol. 2020; 77: 713-724
        • Mottet N
        • van den Bergh RCN
        • Briers E
        • et al.
        EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent.
        Eur Urol. 2020; (S0302-2838(20)30769-7)
      1. Xu J, Bock C, Janisse J, et al. Urologists' perceptions of active surveillance and their recommendations for low-risk prostate cancer patients. Urology.

        • Krishna Fan
        • Jarosek
        • et al.
        Racial Disparities in Active Surveillance for Prostate Cancer.
        J Urol. 2017; 197: 342-349
        • Womble PR
        • Montie JE
        • Ye Z
        • et al.
        Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer.
        Eur Urol. 2015; 67: 44-50
      2. Briganti, MacLenan, Marconi, et al. European Association of Urology (EAU) guidelines: do we care? Reflections from the EAU impact assessment of guidelines implementation and education group. BJU Int. 117:850–851.

        • Bokhorst LP
        • Valdagni R
        • Rannikko A
        • et al.
        A Decade of Active Surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment.
        Eur Urol. 2016; 70: 954-960