Significant morbidity is associated with overtreatment of clinically localized prostate cancer (PCa). Risk stratification tools such as novel biomarkers, MRI and risk calculators are useful in predicting which patients would benefit from active surveillance. This review examines current risk stratification tools in localized PCa and the safety of active surveillance in these patients.

Very low risk, low-risk and favourable intermediate-risk PCa variants may benefit from treatment with active surveillance. These disease categories have been shown (with up to 10-year follow-up) to have survival and cancer-specific complication rates similar to immediate definitive treatment. Novel biomarkers sensitively predict upstaging, recurrence and metastatic progression while multiparametric MRI reliably detects clinically significant PCa and is valuable in the biopsy naïve patient considering active surveillance. Lastly, risk calculators and nomograms are being developed to combine clinical data and provide optimal individualized treatment while minimizing overtreatment in clinically localized disease.

Although large randomized trials are needed to validate treatment pathways, current data supports active surveillance in certain clinically localized PCa. Many tools exist to define and support active surveillance in this group.

Current opinion in urology. 2019 Aug 28 [Epub ahead of print]

Bishoy Hanna, Weranja Ranasinghe, Nathan Lawrentschuk

Northern Sydney Local Health District, New South Wales., Orange Base Hospital, Orange, New South Wales., Urology Unit, Department of Surgery, University of Melbourne, Austin Hospital.