The percentage of prostate cancer with low-risk characteristics has increased since the mid-1990s largely due to widespread prostate-specific antigen (PSA) screening. Over a similar period, the percentage of prostate cancer mortalities has reduced by more than 40%. There is now growing evidence that men with low-risk prostate cancer may not benefit from radical treatment. This has created controversy regarding PSA screening practices and the treatment of low-risk prostate cancer due to concerns of overdiagnosis and overtreatment.
Active surveillance (AS) is an accepted alternative to immediate intervention for favourable-risk prostate cancer and it has shown promise in reducing overtreatment. Several large institutions have reported favourable experiences with AS. However, these select patient cohorts may differ from that of clinical practice, as patients may periodically delay immediate therapy and choose AS despite disease characteristics outside contemporary AS inclusion criteria. We present our experience with AS of a heterogeneous population and report the oncological outcomes following retrospective analysis of a community database with a median 5-year follow-up.
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