Is Active Surveillance Appropriate for all Prostate Cancer?

Many men with low or very low risk prostate cancer benefit from active surveillance. Active surveillance monitors progression with PSA and repeat biopsy to delay treatment until it is necessary. This delays the adverse side effects of treatment and the studies so far show no harm comes from it in selected patients.

A recent study out of Johns Hopkins (Carter, et.al) shows that for men with intermediate risk prostate cancer the pathology at surgery is always adverse, and active surveillance is likely a poor choice. Intermediate risk prostate cancer is a Gleason 3+4=7 or higher grade at biopsy, PSA around 10, <50% biopsy core having cancer. Active surveillance continues to be a good strategy for low risk men, but in intermediate and high risk prostate cancer evidence is clear that treatment is the right next step.