Modern Active Surveillance in Prostate Cancer: A Narrative Review

Trent A Pattenden; Dhanika Samaranayke; Andrew Morton; Wee Loon Ong; Declan G Murphy; Elizabeth Pritchard; Susan Evans; Jeremy Millar; Venu Chalasani; Prem Rashid; Matthew Winter; Ian Vela; David Pryor; Stephen Mark; Nathan Lawrentschuk; Isaac A Thangasamy

doi:10.1016/j.clgc.2022.09.003

Modern Active Surveillance in Prostate Cancer: A Narrative Review

Clin Genitourin Cancer. 2023 Feb;21(1):115-123. doi: 10.1016/j.clgc.2022.09.003. Epub 2022 Sep 8.

Authors

Trent A Pattenden¹, Dhanika Samaranayke², Andrew Morton², Wee Loon Ong³, Declan G Murphy⁴, Elizabeth Pritchard⁵, Susan Evans⁵, Jeremy Millar⁶, Venu Chalasani⁷, Prem Rashid⁸, Matthew Winter⁹, Ian Vela¹⁰, David Pryor¹¹, Stephen Mark¹², Nathan Lawrentschuk¹³, Isaac A Thangasamy¹⁴

Affiliations

¹ Department of Urology, Ipswich Hospital, QLD, Australia. Electronic address: pattendentrent@gmail.com.
² Department of Urology, Ipswich Hospital, QLD, Australia; Faculty of Medicine, University of Queensland, QLD, Australia.
³ Alfred Health Radiation Oncology Service, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia; School of Clinical Medicine, University of Cambridge, UK.
⁴ Division of Cancer Surgery, Peter MacCallum Cancer Centre, VIC, Australia.
⁵ Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia.
⁶ Alfred Health Radiation Oncology Service, VIC, Australia; Central Clinical School, Monash University, VIC, Australia.
⁷ Faculty of Medicine and Health, University of Sydney, NSW, Australia.
⁸ Rural Clinical School, Faculty of Medicine, University of New South Wales, Australia.
⁹ Nepean Urology Research Group, Nepean Hospital, NSW, Australia.
¹⁰ Department of Urology, Princess Alexandra Hospital, QLD, Australia; Australian Prostate Cancer Research Centre, Queensland and The Queensland Bladder Cancer Initiative, School of Biomedical Science, Faculty of Health, Queensland University of Technology, QLD, Australia.
¹¹ Department of Radiation Oncology, Princess Alexandra Hospital, QLD, Australia.
¹² Department of Urology, Christchurch Hospital, New Zealand.
¹³ Division of Cancer Surgery, Peter MacCallum Cancer Centre, VIC, Australia; EJ Whitten Prostate Cancer Research Centre, Epworth, VIC, Australia.
¹⁴ Faculty of Medicine, University of Queensland, QLD, Australia; Nepean Urology Research Group, Nepean Hospital, NSW, Australia.

PMID: 36443163
DOI: 10.1016/j.clgc.2022.09.003

Abstract

The use of PSA screening has led to downstaging and downgrading of prostate cancer at diagnosis, increasing detection of indolent disease. Active surveillance aims to reduce over-treatment by delaying or avoiding radical treatment and its associated morbidity. However, there is not a consensus on the selection criteria and monitoring schedules that should be used. This article aims to summarize the evidence supporting the safety of active surveillance, the current selection criteria recommended and in use, the incidence of active surveillance, barriers existing to its uptake and future developments in patient selection.

Keywords: Active surveillance; Intermediate risk prostate cancer; Low risk prostate cancer; MRI; Risk stratification.

Publication types

Review

MeSH terms

Humans
Male
Morbidity
Patient Selection
Prostate-Specific Antigen
Prostatic Neoplasms* / diagnosis
Prostatic Neoplasms* / epidemiology
Prostatic Neoplasms* / therapy
Watchful Waiting*

Substances

Prostate-Specific Antigen