title: Active surveillance in prostate cancer:  patient selection and triggers for intervention.
abstract: OBJECTIVE
  The long-term safety and effectiveness of active surveillance depends on our ability to select appropriate patients and trigger delayed treatment in those who need it, whereas avoiding intervention in those who do not. In this review, we will consider how recent advances have influenced patient selection for active surveillance and review the range of different intervention triggers that have been proposed.
  
  
  RESULTS
  Several large surveillance cohort studies have been reported recently showing excellent medium-term outcomes in well selected patients, with approximately a third of patients going on to have deferred treatment. Debate continues on the most appropriate eligibility criteria for active surveillance and what triggers for intervention should be used. There is growing interest in the role of transperineal template biopsies and multiparametric MRI, both for patient selection and in identifying triggers for intervention.
  
  
  CONCLUSIONS
  Active surveillance is a well tolerated treatment option in well selected groups of patients. There is no 'one size fits all' set of criteria for patient selection or triggers for intervention but decisions can be guided by information from histology, prostate-specific antigen kinetics and imaging.
authors.affiliation: Academic Urology Unit, Royal Marsden NHS Foundation Trust, Sutton, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lees
authors.forename: Meeta
authors.initials: M
authors.lastname: Durve
authors.forename: Chris
authors.initials: C
authors.lastname: Parker
mesh_terms: D018450:Disease Progression; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D018579:Patient Selection; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D019564:Unnecessary Procedures; D057832:Watchful Waiting