title: Identification of candidates for observation.
abstract: OBJECTIVE
  The clinical value of active surveillance may still be limited due to acceptance and considerable misclassification rates, and inadequate follow-up criteria. This review focuses on the most recent developments in the use of active surveillance and patient-specific factors that may be used to identify patients suitable for this strategy.
  
  
  RESULTS
  The number of patients diagnosed with low-risk prostate cancer has risen. Active surveillance acceptance rates are increasing, but still limited and varying importantly (2-49%). Misclassification is inevitable in all currently used protocols, although most of these patients still have relatively favorable-risk prostate cancer. African-American race, obese, and older-aged patients show more unfavorable intermediate results in an active surveillance situation. These are unlikely to be explained by the small differences in preoperative characteristics only. Psychological profiling may also be added to the selection process. Most studies report intermediate endpoints only.
  
  
  CONCLUSIONS
  Patient-specific factors may be incorporated when identifying patients for active surveillance. This does not imply that active surveillance is not justified in specific groups, but may suggest the need for an intensified and personalized selection, instead of a one-size-fits-all approach.
authors.affiliation: aUtrecht University Medical Centre, Utrecht, The Netherlands bPeter MacCallum Cancer Centre cRoyal Melbourne Hospital, Melbourne, Australia.
authors.forename: Roderick C N
authors.initials: RC
authors.lastname: van den Bergh
authors.forename: Declan G
authors.initials: DG
authors.lastname: Murphy
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Costello
mesh_terms: D002985:Clinical Protocols; D018450:Disease Progression; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D018579:Patient Selection; D057285:Precision Medicine / Q000639:trends*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen