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Minerva Urologica e Nefrologica 2015 September;67(3):247-61

lingua: Inglese

Active surveillance in prostate cancer: a critical review

Zargar H. 1, Giannarini G. 2, Loeb S. 3, Dasgupta P. 4, Murphy D. G. 5, Ficarra V. 2, 6

1 Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia;
2 Urology Unit, Academic Medical Centre Hospital “Santa Maria della Misericordia”, Udine, Italy;
3 Department of Urology and Population Health and the Laura and Isaac Perlmutter Cancer Center, New York University, New York, NY, USA;
4 MRC Centre for Transplantation, NIHR Biomedical Research Centre, King‘s Health Partners, King‘s College London and Department of Urology, Guy‘s Hospital London, UK;
5 Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
6 Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy


The aim of this paper was to examine the eligibility criteria, surveillance protocols and oncological outcomes of published active surveillance (AS) series. We also assessed the evidence for utility of novel tools for optimal risk stratification and surveillance of men suitable for AS. A non-systematic literature search of the Medline, Embase, and Scopus databases was performed in April 2015 using medical subject headings and free-text protocol. The search was conducted by applying free-text protocol with the following search terms: “active surveillance”, “prostate cancer”, “prostatic neoplasm”, “watchful waiting”, “low risk prostate cancer” and “very low risk prostate cancer”. The definition of insignificant disease remains debatable as criteria for patient selection vary among studies. Tools for better selection of candidates and monitoring of the disease process have evolved since the conception of AS, including new biomarkers like phi, mpMRI and alternate biopsy strategies. AS is a sound strategy for reducing overtreatment of men with low-risk, and potentially selected men with intermediate-risk prostate cancer and shorter life expectancy, without compromising overall and cancer specific survival. More data are needed on the optimal integration of the new tools on AS paradigms and on the long-term health impact of AS in different populations.

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