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Volume 10, Pages 2352-2361
Review Article

Active Surveillance for Localized Prostate Cancer – Current Practices and Recommendations

Department of Urology, University of California, Davis Medical Center, Sacramento, CA, USA

Received 22 September 2010; Revised 9 November 2010; Accepted 12 November 2010

Academic Editor: Scott Eggener

Copyright © 2010 Jennifer N. Wu and Marc A. Dall'Era.


Prostate cancer is now the most commonly diagnosed solid tumor in American men, due in part to widespread screening and aggressive diagnostic practices. Prostate cancer autopsy studies show the uniquely high prevalence rates of small, indolent tumors in men dying of other causes. These findings have led to increased concern for the overdetection and overtreatment of prostate cancer. Active surveillance for prostate cancer allows one to limit prostate cancer treatment with concomitant risks of treatment-related morbidity to the men who will benefit the most from aggressive therapies. Several tools have been developed in treated and surveyed men to assist physicians in selecting men with potentially indolent tumors amenable to active surveillance. Recent published results describe institutional experiences with active surveillance and delayed selective therapy for men with low-grade, early prostate cancer. Although median follow-up from these studies is relatively short, the outcomes appear favorable. Data from these reports provide information for selecting men for this approach, as well as for following them over time and determining triggers for further intervention. Ongoing clinical trials with watchful waiting and active surveillance for prostate cancer will ultimately provide improved evidence for managing early, localized disease.