See Expectant management for prostate cancer

Overtreatment of patients with early-stage prostate cancer is a widely recognized problem: most patients with low risk prostate cancer defined as prostate specific antigen level of 10 ng/mL or less, Gleason score 6, and clinical stage T1c or T2a do not benefit from immediate aggressive treatment in terms of lengthening survival.

Only a fraction of men who chose active surveillance (AS) instead of immediate treatment for early stage prostate cancer actually undergo monitoring as recommended.

Guidelines established by the National Comprehensive Cancer Network (NCCN) recommend that men undergoing surveillance for low- to intermediate-risk prostate cancer need to have their prostatic specific antigen (PSA) levels tested at least once every 6 months, have an annual digital rectal exam (DRE), and a repeat biopsy of the prostate within 18 months of their initial diagnosis.

Active surveillance management in low risk patients undergo routine monitoring most commonly using PSA, prostate biopsy, and magnetic resonance imaging: definitive treatment is offered to patients who demonstrate cancer progression during surveillance.

There is some evidence from clinical trials to suggest that surveillance may not be as effective as immediate treatment if patients are not well monitored.

In the ProtecT trial, no differences in prostate cancer-specific mortality between immediate treatment groups and those assigned to surveillance.

The incidence of disease progression and metastases in the surgery and radiotherapy arms was lower at a median follow-up of 10 years in the immediate treatment group than in the active surveillance arm.

The median age at which men die from prostate cancer in the United States is 80.

Patients may be harmed by surgical or radiation treatments that lead to negative short term and long term effects on the quality of life.

Overtreatment for early stage prostate cancer is estimated to cause more than $300 million in avoidable annual Medicare spending.

Multiple studies indicate that active surveillance can spare about 50% of low risk patients from treatment, with little little risk of developing metastatic disease:That is missing the opportunity for cure.

Among black patients under surveillance for prostate cancer, the black cohort exhibited higher rates of cancer progression than White patients and remained on active surveillance for relatively shorter periods, 31.2 months vs not reached.

Black patients diagnosed with low risk prostate cancer may have a more biologically aggressive disease compared with White patients.

Studies have shown the 22 to 33% of patients with low risk prostate cancer are upgraded while on active surveillance and a small number of patients on active surveillance. ultimately die of prostate cancer.

The Canary Prostate active surveillance study among 2155 patients with localized prostate cancer at 10 years after diagnosis 49% of men remain free of progression or treatment, less than 2% developed metastatic disease, and less than one percent died of their disease during surveillance:active surveillance is an effective management strategy for patients diagnosed with favorable risk prostate cancer.

In this study the 10 year incidence of metastasis or prostate cancer mortality was 1.4% and 0.1%, respectively.

The 10 year incidence of upgrading at biopsy and definitive treatment were 43% and 49%, respectively.

In this study later progression and treatment during surveillance was not associated with worse outcomes.

After 15 years of follow up prostate cancer specific mortality was low regardless of the treatment assigned: between monitoring, surgery or radiation (ProecT study group).

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