title: Active surveillance for prostate cancer: a narrative review of clinical guidelines.
abstract: In the past decade active surveillance (AS) of men with localized prostate cancer has become an increasingly popular management option, and a range of clinical guidelines have been published on this topic. Existing guidelines regarding AS for prostate cancer vary widely, but predominantly state that the most suitable patients for AS are those with pretreatment clinical stage T1c or T2 tumours, serum PSA levels <10 ng/ml, biopsy Gleason scores of 6 or less, a maximum of one or two tumour-positive biopsy core samples and/or a maximum of 50% of cancer per core sample. Following initiation of an AS programme, most guidelines recommend serial serum PSA measurements, digital rectal examinations and surveillance biopsies to check for and identify pathological indications of tumour progression. Definitions of disease reclassification and progression differ among guidelines and multiple criteria for initiation of definitive treatment are proposed. The variety of descriptions of criteria for clinically insignificant prostate cancer indicates a lack of consensus on optimal AS and intervention thresholds. A single set of guidelines are needed in order to reduce variations in clinical practice and to optimize clinical decision-making. To enable truly evidence-based guidelines, further research that combines existing evidence, while also gathering information from more long-term studies is needed.
authors.affiliation: Department of Urology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Sophie M
authors.initials: SM
authors.lastname: Bruinsma
authors.affiliation: Department of Urology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Chris H
authors.initials: CH
authors.lastname: Bangma
authors.affiliation: Department of Urology, 550 16th Street, University of California, San Francisco, Mailbox Code 1695, San Francisco, California 94143, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.affiliation: Department of Urology, 550 16th Street, University of California, San Francisco, Mailbox Code 1695, San Francisco, California 94143, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Leapman
authors.affiliation: Department of Urology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Rannikko
authors.affiliation: Urology Research, University College London &University College London Hospitals Trust, 132 Hampstead Road, London NW1 2PS, UK.
authors.forename: Neophytos
authors.initials: N
authors.lastname: Petrides
authors.affiliation: Austin Hospital, Department of Surgery, Level 8 Harold Stokes Building, 145 Studley Road, Heidelberg, Victoria 3084, Australia.
authors.forename: Mahesha
authors.initials: M
authors.lastname: Weerakoon
authors.affiliation: Department of Urology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Leonard P
authors.initials: LP
authors.lastname: Bokhorst
authors.affiliation: Department of Urology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Monique J
authors.initials: MJ
authors.lastname: Roobol
mesh_terms: D051517:Digital Rectal Examination / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D060787:Neoplasm Grading / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods / Q000592:standards; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen
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