Active surveillance: The European experience

PC is the most frequently diagnosed malignancy in men across Europe. After PSA became available as a potential screening tool for the early detection of PC, the incidence of the disease has been increasing, as well as the relative amount of low-risk and potentially overdiagnosed disease. Active surveillance has emerged over the last few years as an alternative treatment strategy for the management of potentially overdiagnosed prostate cancer.

In this chapter, the European studies and initiatives with respect to screening for prostate cancer, and feasibility and effectiveness of active surveillance, are described. There are two ongoing prospective active surveillance studies in Europe; the study at the Royal Marsden Hospital in the United Kingdom was initiated in 2002, and the PRIAS study was initiated in the Netherlands in 2006 and is now an international web-based program with the highest number of participants worldwide.

Current results regarding active surveillance look promising, but longer follow-up is warranted to improve inclusion and follow-up criteria and evaluate the safety of this approach. Furthermore, future research will focus on the improvement of the individualized management of patients with low-risk prostate cancer by means of predictive tools, and the incorporation of new biomarkers and imaging techniques for the differentiation between potentially aggressive and indolent disease.