Active surveillance for prostate cancer: a narrative review of clinical guidelines

Sophie M. Bruinsma, Chris H Bangma, Peter R. Carroll, Michael S Leapman, Antti Rannikko, Neophytos Petrides, Mahesha Weerakoon, Leonard P. Bokhorst, Monique J. Roobol, Movember GAP3 consortium

Research output: Contribution to journalArticle


In the past decade active surveillance (AS) of men with localized prostate cancer has become an increasingly popular management option, and a range of clinical guidelines have been published on this topic. Existing guidelines regarding AS for prostate cancer vary widely, but predominantly state that the most suitable patients for AS are those with pretreatment clinical stage T1c or T2 tumours, serum PSA levels <10 ng/ml, biopsy Gleason scores of 6 or less, a maximum of one or two tumour-positive biopsy core samples and/or a maximum of 50% of cancer per core sample. Following initiation of an AS programme, most guidelines recommend serial serum PSA measurements, digital rectal examinations and surveillance biopsies to check for and identify pathological indications of tumour progression. Definitions of disease reclassification and progression differ among guidelines and multiple criteria for initiation of definitive treatment are proposed. The variety of descriptions of criteria for clinically insignificant prostate cancer indicates a lack of consensus on optimal AS and intervention thresholds. A single set of guidelines are needed in order to reduce variations in clinical practice and to optimize clinical decision-making. To enable truly evidence-based guidelines, further research that combines existing evidence, while also gathering information from more long-term studies is needed.

Original languageEnglish
Pages (from-to)151-67
Number of pages17
JournalNature Reviews Urology
Issue number3
Publication statusPublished - Mar 2016
Externally publishedYes



  • Digital Rectal Examination
  • Humans
  • Male
  • Neoplasm Grading
  • Practice Guidelines as Topic
  • Prostate-Specific Antigen
  • Prostatectomy
  • Prostatic Neoplasms
  • Risk Factors
  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Review

Cite this

Bruinsma, S. M., Bangma, C. H., Carroll, P. R., Leapman, M. S., Rannikko, A., Petrides, N., Weerakoon, M., Bokhorst, L. P., Roobol, M. J., & Movember GAP3 consortium (2016). Active surveillance for prostate cancer: a narrative review of clinical guidelines. Nature Reviews Urology, 13(3), 151-67.