Active Surveillance for Screen-Detected Prostate Cancer - A Strategy for the Future?

For good reasons, newly detected prostate cancer must not necessarily be treated with curative intent: Prostate-specific antigen screening leads to overdiagnosis in 54%. Current international guidelines on the treatment of prostate cancer take this development into account by recommending "active surveillance" (AS) as an equitable treatment option for low-risk prostate cancer. Data on the natural history of prostate cancer indicates that only few men with localised prostate cancer profit from active therapy. Currently, there are 6 series on AS with more than 2000 patients documented in the literature, 200 of them having a follow-up of ten years or more. Disease-specific survival is 99-100%, and there is no hint at that progression was detected too late for effective treatment. The rates of biochemical recurrence and pathohistological findings of deferred treatment compare well with those of immediate intervention. Thus AS is a safe treatment option for a well-defined patient cohort that has only a small chance of benefit but a high risk of harm from curative treatment.