Active Surveillance for Low-risk Prostate Cancer: Some Questions Are Answered, but Many Questions Remain

Abstract

In this issue of European Urology, short-term data from the Prostate Cancer Research International: Active Surveillance (PRIAS) study are presented [1]. The PRIAS study comprises the world’s largest patient cohort followed in an active surveillance (AS) protocol. In thisworldwide initiative, about 2500 patients from 17 countries and 3 continents with very low-risk disease are presently being followed in a mutual protocol. This protocol suggests prostate-specific antigen (PSA) measurements every 3 mo and later every 6 mo, and repeat biopsies 1, 4, and 7 yr after initiating AS. Reclassification of the disease with subsequent recommendation for active treatment is defined as more than two positive cores or Gleason score >6 and/or a PSA doubling time <3 yr. The authors and especially those who initiated this Internet-based protocol should be commended for this project. The data that are already generated and the data that will be produced in the coming years from this endeavour are of tremendous importance. With a higher acceptance of the role of AS, the number of men enrolled in the PRIAS study is growing rapidly. We must try to enrol as many patients in protocols like this once they have decided on AS to increase our knowledge about this therapeutic option. Otherwise the lingering uncertainties of AS will certainly not be resolved. Our centre actively participates in the PRIAS study, and we strongly recommend those urologists who recommend AS to their patients to join this initiative. The protocol is readily available online (https:// www.prias-project.org). It offers a standardised scheme that facilitates AS for both urologists and patients. The PRIAS study offers patient enrolment regardless of the countrywhere the patient is being treated and can serve as a model for future studies with a new way of recruiting patients for large-scale investigations.