Active surveillance for intermediate-risk prostate cancer: yes, but for whom?

Curr Opin Urol. 2019 Nov;29(6):605-611. doi: 10.1097/MOU.0000000000000671.


Purpose of review: Active surveillance is becoming more widely accepted as an initial management option for carefully selected men with favorable intermediate-risk prostate cancer (PCa). As prospective active surveillance cohorts mature sufficiently to begin evaluating longer-term outcomes, consensus on more precise evidence-based guidelines is needed to identify the patient cohorts who may be safely managed with active surveillance and what the ideal surveillance protocol entails.

Recent findings: Long-term outcomes updates have suggested a trend toward worse 15-year survival outcomes for intermediate-risk patients on active surveillance compared with definitive treatment, but 'intermediate-risk' is a broad category and there is a subset of favorable intermediate-risk patients for whom survival outcomes remain equivalent. Promising updates to current risk stratification include consideration of genomic classifiers, advanced imaging and more nuanced interpretation of biopsy results.

Summary: Despite widespread acknowledgement of the pitfalls of overtreatment in clinically localized PCa, utilization of active surveillance in the intermediate-risk population remains marginal, in part due to the absence of easily interpretable consensus recommendations. As more long-term outcomes data become available for this subgroup, the field is now poised to refine the definition of favorable intermediate-risk patients for whom active surveillance is a safe, evidence-based first-line management option.

Publication types

  • Review

MeSH terms

  • Disease-Free Survival
  • Humans
  • Male
  • Neoplasm Grading
  • Prostate-Specific Antigen
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / therapy
  • Risk Assessment / methods*
  • Risk Factors
  • Watchful Waiting*


  • Prostate-Specific Antigen