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Low-risk prostate cancer can and should often be managed with active surveillance and selective delayed intervention

Nature Clinical Practice Urology volume 5, pages 2–3 (2008)Cite this article

Low-risk prostate cancer constitutes 50–60% of all newly diagnosed prostate cancers.1 Patients with low-risk prostate cancer have a long window of curability and a relatively low risk of prostate cancer mortality at 20 years or more. Evidence indicates that, among populations heavily screened for prostate cancer, treating all patients radically results in overtreatment.2 Active surveillance of patients with low-risk prostate cancer followed by intervention when pre-specified criteria are fulfilled is an approach that could prevent unnecessary overtreatment.

This strategy is a safe and feasible option in patients with low-risk prostate cancer for several reasons. First, these patients can be identified with reasonable accuracy. Second, no treatment for clinically insignificant prostate cancer exists that has minimal adverse effects and cost. Third, patients who are initially classified as having low-risk prostate cancer, and are later reclassified as having high-risk prostate cancer, can be treated radically and are cured in most cases. Finally, the psychological burden of living with untreated cancer has less effect on quality of life than unnecessary but curative therapy. To implement active surveillance and delayed intervention, patients must be identified who have a low likelihood of disease progression. They must be closely monitored for changes in their cancer, and reasonable criteria for intervention must be fulfilled. Reducing the psychological burden of living with untreated cancer should also be addressed.

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  1. Sunnybrook & Women's College Health Sciences Centre, 2075 Bayview Avenue, # MG 408, Toronto, Ontario M4N 3M5, Canada laurence.klotz@sunnybrook.ca

Authors and Affiliations

  1. and Chief of the Division of Urology at the Sunnybrook & Women's College Health Sciences Centre, L Klotz is a Professor of Surgery at the University of Toronto, Toronto, Canada.,

    Laurence Klotz

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  1. Laurence Klotz
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Klotz, L. Low-risk prostate cancer can and should often be managed with active surveillance and selective delayed intervention. Nat Rev Urol 5, 2–3 (2008). https://doi.org/10.1038/ncpuro0993

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