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Even the most ardent advocates of prostate cancer screening agree that prostate cancer is overdiagnosed and overtreated in the U.S. Despite recent reports highlighting the limitations and drawbacks of prostate cancer screening (JW Mar 18 2009), many of the 192,000 men in the U.S. who receive diagnoses of prostate cancer this year (CA Cancer J Clin 2009; 59:225) will have learned about their disease as a result of screening, and most will undergo some form of local therapy with curative intent. To address the problem of excessive treatment, researchers are investigating delayed therapy plus active surveillance as an alternative approach.
Beginning in 1995, researchers in Canada offered active surveillance — defined based on selective, delayed…