title: Active surveillance for prostate cancer.
abstract: It is worth distinguishing between the two strategies of expectant management for prostate cancer. Watchful waiting entails administering non-curative androgen deprivation therapy to patients on development of symptomatic progression, whereas active surveillance entails delivering curative treatment on signs of disease progression. The objectives of the two management strategies and the patients enrolled in either are different: (i) to review the role of active surveillance as a management strategy for patients with low-risk prostate cancer; and (ii) review the benefits and pitfalls of active surveillance. We carried out a systematic review of active surveillance for prostate cancer in the literature using the National Center for Biotechnology Information's electronic database, PubMed. We carried out a search in English using the terms: active surveillance, prostate cancer, watchful waiting and conservative management. Selected studies were required to have a comprehensive description of the demographic and disease characteristics of the patients at the time of diagnosis, inclusion criteria for surveillance, and a protocol for the patients' follow up. Review articles were included, but not multiple papers from the same datasets. Active surveillance appears to reduce overtreatment in patients with low-risk prostate cancer without compromising cancer-specific survival at 10 years. Therefore, active surveillance is an option for select patients who want to avoid the side-effects inherent to the different types of immediate treatment. However, inclusion criteria for active surveillance and the most appropriate method of monitoring patients on active surveillance have not yet been standardized.
authors.affiliation: Urology Department, 12 de Octubre University Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Romero-Otero
authors.affiliation: Urology Department, 12 de Octubre University Hospital, Madrid, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: García-Gómez
authors.affiliation: Urology Department, 12 de Octubre University Hospital, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Duarte-Ojeda
authors.affiliation: Urology Department, 12 de Octubre University Hospital, Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Rodríguez-Antolín
authors.affiliation: Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.
authors.forename: Antoni
authors.initials: A
authors.lastname: Vilaseca
authors.affiliation: Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.|Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Sigrid V
authors.initials: SV
authors.lastname: Carlsson
authors.affiliation: Urology Department, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.
authors.forename: Karim A
authors.initials: KA
authors.lastname: Touijer
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D000728:Androgens / Q000378:metabolism; D018450:Disease Progression; D006801:Humans; D008297:Male; D000069342:Medical Overuse; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D057832:Watchful Waiting / Q000191:economics / Q000379:methods* / Q000592:standards
chemical_list: D000726:Androgen Antagonists; D000728:Androgens; D017430:Prostate-Specific Antigen
keywords: active surveillance; biological markers; biopsy; magnetic resonance imaging; prostatic neoplasms