title: Current Management Strategy for Active Surveillance in Prostate Cancer.
abstract: OBJECTIVE
  Active surveillance has been increasingly utilized as a strategy for the management of favorable-risk, localized prostate cancer. In this review, we describe contemporary management strategies of active surveillance, with a focus on traditional stratification schemes, new prognostic tools, and patient outcomes.
  
  
  RESULTS
  Patient selection, follow-up strategy, and indication for delayed intervention for active surveillance remain centered around PSA, digital rectal exam, and biopsy findings. Novel tools which include imaging, biomarkers, and genetic assays have been investigated as potential prognostic adjuncts; however, their role in active surveillance remains institutionally dependent. Although 30-50% of patients on active surveillance ultimately undergo delayed treatment, the vast majority will remain free of metastasis with a low risk of dying from prostate cancer. The optimal method for patient selection into active surveillance is unknown; however, cancer-specific mortality rates remain excellent. New prognostication tools are promising, and long-term prospective, randomized data regarding their use in active surveillance will be beneficial.
authors.affiliation: Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA.
authors.forename: Jamil S
authors.initials: JS
authors.lastname: Syed
authors.affiliation: Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Javier-Desloges
authors.affiliation: Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tatzel
authors.affiliation: Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA.
authors.forename: Ansh
authors.initials: A
authors.lastname: Bhagat
authors.affiliation: Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Nguyen
authors.affiliation: Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hwang
authors.affiliation: Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA. Preston.Sprenkle@yale.edu.
authors.forename: Preston C
authors.initials: PC
authors.lastname: Sprenkle
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D019468:Disease Management; D006801:Humans; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor
keywords: Active surveillance; Biomarkers; Gene assay; Prostate cancer