Active Surveillance of Favorable-Risk Prostate Cancer

Active surveillance (AS) of prostate cancer is a structured, prospective management approach, in which men are monitored with serial prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and prostate biopsies. It has been proposed as an effective approach for patients with favorable-risk disease, i.e., those at low risk for developing lethal metastasis. However, the data regarding patient prognosis has come only from institutional experiences.

Now, investigators report outcomes from a prospective AS program involving 1298 men over a 20-year period. Eligible patients had either very low risk (T1c, PSA density <0.15 ng/mL, Gleason score ≤6, ≤2 positive biopsy cores, and ≤50% of a core involved) or low-risk disease (≤T2a, P…