The role of active surveillance in the management of prostate cancer.

In 2010, NCCN incorporated active surveillance (AS) into the NCCN Clinical Practice Guidelines in Oncology for Prostate Cancer, and the 2012 update serves as an excellent resource with the most current evidence regarding treatment options for men with all stages of disease. However, the lack of clinical trials that directly compare various treatment modalities or identify the best management, especially for men with low-risk prostate cancer, makes the decision-making process difficult for both patients and physicians. Although general agreement exists on definitions of candidates for AS-men with low-volume and low-grade disease thought to be at low risk for rapid progression-several key issues remain in establishing and supporting the role of AS in the management of prostate cancer, such as optimal timing and appropriate triggers for active treatment. The decision to initially pursue AS rather than active treatment after prostate cancer diagnosis is complex and involves myriad factors, including estimation of life expectancy, consideration of quality of life, and assessment of ultimate oncologic outcome.