title: Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers.
abstract: OBJECTIVE
  Low-risk prostate cancer is found in about half of newly diagnosed men subjected to PSA screening.
  
  
  METHODS
  To define the role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers, an invited international panel of practicing physicians in the field of localized prostate cancer discussed the available literature in three consecutive meetings to come to a broad interpretation of the available data.
  
  
  RESULTS
  The panel ("new prostate cancer management group," npm) agreed on the following observations. In most men with a low-volume Gleason 6 tumor, initial conservative management is appropriate. In men with a larger unifocal Gleason score 6 or 3 + 4 lesion, focal therapy, although still considered an investigational approach, appears to be a suitable option in early non-randomized comparison studies. Furthermore, in patients with multifocal small satellite Gleason 6 lesions in the presence of a larger index lesion, focal therapy of the index lesion is an option. For patients with high-grade, large-volume disease, or in young men with evidence of high-volume multifocal low-grade prostate cancer, whole-gland treatment should be considered.
  
  
  CONCLUSIONS
  Active surveillance is a preferred and safe option for low-risk prostate cancer. Focal therapy is still under investigation, but the available phase II data are promising. Clinical benefits must be shown in prospective trials. With improved imaging, focal therapy may be an option for patients not choosing active surveillance with low-risk disease, progression upon active surveillance or intermediate-risk cancers with a localizable lesion.
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands, h_vanderpoel@hotmail.com.
authors.forename: Henk
authors.initials: H
authors.lastname: van der Poel
authors.forename: Laurence
authors.initials: L
authors.lastname: Klotz
authors.forename: Gerald
authors.initials: G
authors.lastname: Andriole
authors.forename: Abdel-Rahmène
authors.initials: AR
authors.lastname: Azzouzi
authors.forename: Anders
authors.initials: A
authors.lastname: Bjartell
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Freddy
authors.initials: F
authors.lastname: Hamdy
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Paolo
authors.initials: P
authors.lastname: Palma
authors.forename: Arturo Rodriguez
authors.initials: AR
authors.lastname: Rivera
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
mesh_terms: D001707:Biopsy, Needle; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007610:Kallikreins / Q000097:blood; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D057832:Watchful Waiting
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen