Active surveillance: Current and future directions

摘要

Lest anyone persisted in the view that all patients with localized prostate cancer warrant aggressive management, the US Preventive Services Task Force recommendation against Prostate Specific Antigen (PSA) screening was the final nail in the coffin. The damning level 'D' recommendation was based largely on concerns about overdiagnosis and over-treatment associated with early detection of prostate cancer. The message was a profound wake up call for the need for change in how clinicians manage this disease. That message was doubly reinforced by the Prostate Intervention Vs Observation Trial (PIVOT) study, which showed that, although some men benefited from treatment, there was absolutely no evidence of benefit in men with favorable risk disease.