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Active surveillance for prostate cancer: selection criteria, guidelines, and outcomes

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Abstract

Introduction

Active surveillance (AS) has been widely adopted for the management of men with low-risk prostate cancer. However, there is still a lack of consensus surrounding the optimal approach for monitoring men in AS protocols. While conservative management aims to reduce the burden of invasive testing without compromising oncological safety, inadequate assessment can result in misclassification and unintended over- or undertreatment, leading to increased patient morbidity, cost, and undue risk. No universally accepted AS protocol exists, although numerous strategies have been developed in an attempt to optimize the management of clinically localized disease. Variability in selection criteria, reclassification, triggers for definitive treatment, and follow-up exists between guidelines and institutions for AS. In this review, we summarize the landscape of AS by providing an overview of the existing AS protocols, guidelines, and their published outcomes.

Methods

A comprehensive electronic search was performed to identify representative studies and guidelines pertaining to AS selection criteria and outcomes.

Conclusion

While AS is a safe and increasingly utilized treatment modality for lower-risk forms of PCa, ongoing research is needed to optimize patient selection as well as surveillance protocols along with improved implementation across practices. Further, assessment of companion risk assessment tools, such as mpMRI and tissue-based biomarkers, is also needed and will require rigorous prospective study.

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Authors and Affiliations

  1. Department of Urology, University of Michigan Health System, University of Michigan, 1500 E Medical Center Drive, 7308 CCC, Ann Arbor, MI, 48109, USA

    Colton H. Walker, Kathryn A. Marchetti, Udit Singhal & Todd M. Morgan

  2. Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA

    Udit Singhal & Todd M. Morgan

Authors
  1. Colton H. Walker
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  2. Kathryn A. Marchetti
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  3. Udit Singhal
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  4. Todd M. Morgan
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Contributions

CHW: project development, data collection, manuscript writing. KAM: project development, data collection, manuscript writing. US: project development, data collection, manuscript writing. TMM: project development, data collection, manuscript writing.

Corresponding author

Correspondence to Todd M. Morgan.

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Conflict of interest

Colton H. Walker, Kathryn A. Marchetti and Udit Singhal: they have no relationship to disclose. Todd M. Morgan, Consulting: Blue Earth, Research Funding: Myriad Genetics, Decipher Biosciences.

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Walker, C.H., Marchetti, K.A., Singhal, U. et al. Active surveillance for prostate cancer: selection criteria, guidelines, and outcomes. World J Urol 40, 35–42 (2022). https://doi.org/10.1007/s00345-021-03622-8

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  • DOI: https://doi.org/10.1007/s00345-021-03622-8

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