Active Surveillance vs. Initial Treatment for Low-Risk Prostate Cancer

Since prostate-specific antigen (PSA) was introduced into clinical practice in the late 1980s, PSA-based screening has become ubiquitous in the U.S. Despite somewhat conflicting evidence from randomized screening trials, there is little debate that overdiagnosis and overtreatment of prostate cancer remain important issues.

Active surveillance (AS) is a strategy of close monitoring of carefully selected patients who have low-risk prostate cancer. The goal of AS is to avoid treatment — unless there is evidence of disease progression or a change in patient preference — without substantially compromising the ability to proceed with curative-intent therapy and achieve outcomes similar to those that would have been obtained with initial treatment.…