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<p>Active surveillance (AS) is the preferred strategy for managing localized prostate cancer of low risk (International Society of Urological Pathology [ISUP]&#xa0;1) and, under specific conditions, intermediate risk (ISUP&#xa0;2). It aims to preserve quality of life with minimal intervention, while avoiding immediate treatment. The ISUP grading system, replacing the Gleason score, provides a&#xa0;reliable framework for risk stratification. ISUP&#xa0;1 tumors feature favorable histology, limited spread, and low prostate-specific antigen (PSA) levels. Advances in diagnostics, such as multiparametric MRI (mpMRI) and fusion biopsies, have lowered the risk of upgrading to ISUP ≥ 3 to below 10%. ISUP&#xa0;2 tumors may also qualify for AS if adverse features like cribriform growth or a&#xa0;high proportion of Gleason pattern&#xa0;4 are absent. The ProtecT study shows AS achieves similar cancer-specific survival to radical treatments, with a&#xa0;slight reduction in metastasis-free survival. Patients benefit from better preservation of continence and sexual function. Strict monitoring with regular PSA tests, mpMRI, and repeat biopsies is crucial for detecting progression early. Tools like the PRECISE score standardize radiological assessments and minimize unnecessary interventions. Patients with ISUP ≥ 3, aggressive histological features, or PSA density &gt; 0.15 ng/ml/cc are typically unsuitable for AS. Modern studies confirm AS as a&#xa0;safe, quality-of-life-focused option, globally recognized as the standard of care for low-risk patients and increasingly applicable to selected intermediate-risk cases.</p>

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„Active surveillance“ als Standard beim organbegrenzten Prostatakarzinom des niedrigen und intermediären Risikos

  • 期刊论文

  • 发表日期：

    2025年6月23日

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  • A. Fehr,
  • F. Fischbach,
  • J. Vogt,
  • M. Schostak

摘要

Active surveillance (AS) is the preferred strategy for managing localized prostate cancer of low risk (International Society of Urological Pathology [ISUP] 1) and, under specific conditions, intermediate risk (ISUP 2). It aims to preserve quality of life with minimal intervention, while avoiding immediate treatment. The ISUP grading system, replacing the Gleason score, provides a reliable framework for risk stratification. ISUP 1 tumors feature favorable histology, limited spread, and low prostate-specific antigen (PSA) levels. Advances in diagnostics, such as multiparametric MRI (mpMRI) and fusion biopsies, have lowered the risk of upgrading to ISUP ≥ 3 to below 10%. ISUP 2 tumors may also qualify for AS if adverse features like cribriform growth or a high proportion of Gleason pattern 4 are absent. The ProtecT study shows AS achieves similar cancer-specific survival to radical treatments, with a slight reduction in metastasis-free survival. Patients benefit from better preservation of continence and sexual function. Strict monitoring with regular PSA tests, mpMRI, and repeat biopsies is crucial for detecting progression early. Tools like the PRECISE score standardize radiological assessments and minimize unnecessary interventions. Patients with ISUP ≥ 3, aggressive histological features, or PSA density > 0.15 ng/ml/cc are typically unsuitable for AS. Modern studies confirm AS as a safe, quality-of-life-focused option, globally recognized as the standard of care for low-risk patients and increasingly applicable to selected intermediate-risk cases.