Aggressive Prostate Cancer in Patients Treated with Active Surveillance

SIMPLE SUMMARY: Active surveillance is a strategy used to manage early-stage prostate cancer without immediate treatment, aiming to maintain patients’ quality of life. However, concerns remain about identifying “aggressive prostate cancer” within the active surveillance cohort, which refers to cancers with a higher potential for progression. We defined aggressive prostate cancer within the active surveillance cohort as follows: a cancer that is not an indication for active surveillance, despite low-risk or favorable intermediate-risk prostate cancer, and will undergo pathological upgrading during the course of active surveillance monitoring. The identification of aggressive prostate cancer during active surveillance is crucial, as it indicates the need for a shift in the treatment strategy. The detection of aggressive prostate cancer in these cohorts enables a timely intervention and the initiation of appropriate definitive treatment options to improve patient outcomes. To tackle this, previous studies have suggested a personalized follow-up approach that uses a mix of clinical data, biomarkers, and genetic factors to assess risk. As active surveillance indications expand, the importance of identifying aggressive prostate cancer through a personalized risk-based follow-up is expected to increase. ABSTRACT: Active surveillance has emerged as a promising approach for managing low-risk and favorable intermediate-risk prostate cancer (PC), with the aim of minimizing overtreatment and maintaining the quality of life. However, concerns remain about identifying “aggressive prostate cancer” within the active surveillance cohort, which refers to cancers with a higher potential for progression. Previous studies are predictors of aggressive PC during active surveillance. To address this, a personalized risk-based follow-up approach that integrates clinical data, biomarkers, and genetic factors using risk calculators was proposed. This approach enables an efficient risk assessment and the early detection of disease progression, minimizes unnecessary interventions, and improves patient management and outcomes. As active surveillance indications expand, the importance of identifying aggressive PC through a personalized risk-based follow-up is expected to increase.