title: Management of intermediate-risk prostate cancer with active surveillance: never or sometimes?
abstract: OBJECTIVE
  Active surveillance has become the recommended management strategy for most patients with low-risk prostate cancer (PCa), but whether surveillance criteria can be expanded without compromising oncologic outcomes is a matter of debate. Whereas there is essentially uniform consensus that those with low-risk disease can be safely managed with AS, those with intermediate-risk disease, younger men and African-American men are often excluded.
  
  
  RESULTS
  Outcome data for intermediate-risk patients managed by active surveillance demonstrate acceptable oncologic outcomes, but there is also evidence that such patients have higher rates of progression, adverse disease and metastatic disease. Studies evaluating the utility of quantitative Gleason grade, the use of biomarkers and multiparametric MRI are emerging and are likely to refine risk assessment. Literature describing the effects of young age on outcomes is lacking, but early data appear promising. Data on African-American men show varied results that are sometimes contradictory and further investigation is needed to elucidate the impact of race, independent of socioeconomic status.
  
  
  CONCLUSIONS
  Patients with intermediate-risk PCa should not be excluded from active surveillance based on any single, borderline criterion; rather, treatment decisions should be based on the full clinical picture, and may be further refined by patient characteristics and adjunctive tools.
authors.affiliation: Department of Urology, UCSF - Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Selma
authors.initials: S
authors.lastname: Masic
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Washington
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: D000066491:Clinical Decision-Making; D018450:Disease Progression; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D057832:Watchful Waiting