title: Active surveillance in prostate cancer: a concept analysis.
abstract: OBJECTIVE
  To report an analysis of the concept of active surveillance.
  
  
  BACKGROUND
  Prostate cancer has become more prevalent since the introduction of PSA screening, however, many men are diagnosed with low-risk disease that may not require treatment. Active surveillance is a treatment strategy used to avoid treatment and related adverse effects when immediate treatment is not necessary. A universal definition is lacking.
  
  
  METHODS
  Concept analysis.
  
  
  METHODS
  The CINAHL, PubMed, Scopus, Cochrane Library and Google Scholar databases were searched for literature published between 1980 and 2014 using the term active surveillance.
  
  
  METHODS
  The method of Walker and Avant (2010) was used to analyse the concept of active surveillance, specifically within the context of prostate cancer.
  
  
  RESULTS
  Key attributes of active surveillance emerging from the analysis include: regular and purposeful monitoring, early detection of disease progression and planned curative intervention if necessary. Multiple terms are used in the literature to refer to the concept of active surveillance. Active surveillance can cause uncertainty, and prompt men to make lifestyle changes and seek more information on prostate cancer.
  
  
  CONCLUSIONS
  Active surveillance is not well understood, and ambiguity remains around the concept. Active surveillance and watchful waiting are used interchangeably in the literature and in clinical practice, but in fact do not refer to the same strategy. Active surveillance can generate significant uncertainty for the patient and family, which may be a barrier to choosing it as a treatment strategy and nursing research in this area is limited.
  
  
  CONCLUSIONS
  Nurses need a clear understanding of active surveillance and how it differs from other strategies in order to reduce ambiguity around the concept. Nurses must be aware of the uncertainty accompanying active surveillance, and a need exists for continued nursing research in this area.
authors.affiliation: CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Horrill
mesh_terms: D000368:Aged; D018450:Disease Progression; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D057832:Watchful Waiting
keywords: Uncertainty in Illness Theory; active surveillance; concept analysis; nurses; nursing; prostate cancer; uncertainty; watchful waiting