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.