Active Surveillance for Low-risk Prostate Cancer: The European Association of Urology Position in 2018.

Abstract

Active surveillance (AS) represents a well-recognized management option for many patients with low- and very low-risk prostate cancer (PCa). AS aims to reduce overtreatment whilst ensuring curative treatment for those in whom it is needed, without losing the window of curability. While long-term series have confirmed the safety of AS in carefully selected patients, this has resulted in new clinical questions. Can the inclusion criteria be expanded? Is there a role for biomarkers and multiparametric magnetic resonance imaging at diagnosis or during AS? What is the optimal follow-up schedule as well as the most meaningful trigger for definitive treatment? These questions, together with increasingly adopted heterogeneous protocols in AS, have prompted the European Association of Urology to produce a position paper corroborated by a summary of the scientific background on AS. Active surveillance (AS) is becoming a widely adopted strategy for patients affected by low-risk prostate cancer. While a formal systematic review on the topic will soon be available, the European Association of Urology has produced specific statements for different open questions on AS.