Active surveillance for low-risk prostate cancer

During the last decades, incidence of prostate cancer has increased at the expense of cases at low-risk of progression. Meanwhile, the concept of active surveillance has gained widespread acceptance in order to decease the risk of overtreatment. Active surveillance is based on a strict patient monitoring to detect potential disease progression and to propose on time a radical differed treatment with no increased oncologic risk. Patients without progression can continue active surveillance avoiding potential functional consequences of radical treatment. The short and mid-term oncologic follow-up confirmed the oncologic safety of active surveillance with a rate of cumulative differed treatment approaching 30%. To date, active surveillance is recommended by several guidelines, and widely offered by urologists. The inclusion criteria remain subject to debate due to a lack of consensus. Improving the selection of low-risk prostate cancers (MRI, biomarkers) highly relevant due to a significant risk of undergrading of disease at diagnosis. Moreover, due to the slow time evolution of these low-risk cancers, a long-term confirmation of oncological results seems necessary.