Choosing Wisely:

Don’t treat low-risk clinically localized prostate cancer (e.g., Gleason score is less than 7, PSA less than 10.0 ng/mL, and tumor stage T2 or less) without discussing active surveillance as part of the shared decision-making process.

Rationale and Comments: The ultimate choice of treatment should be based on shared decision making and individualized to the patient’s disease characteristics, his overall health, and his personal preferences. The disparity between prostate cancer incidence and mortality implies that many men may not benefit from definitive treatment of localized disease. For men with newly diagnosed low-risk prostate cancer, an active surveillance program represents a valid option that should be discussed. Active surveillance provides a monitored approach that can spare some men the potential risks of definitive treatment while selectively providing effective treatment for more aggressive cancers that warrant intervention.
Sponsoring Organizations:
  • American Urological Association
  • Sources:
  • American Urological Association guidelines
  • Disciplines:
  • Urologic
  • Oncologic
  • References: • Sanda MG, Chen RC, Crispino T, Freedland S, Greene K, Klotz LH, Makarov DV, Nelson JB, Reston J, Rodrigues G, Sandler HM, Taplin ME, Cadeddu JA. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline [INTERNET]. [Linthicum (MD)]: American Urological Association /American Society for Radiation Oncology/Society of Urologic Oncology; 2017 April [cited 2017 May 4]. Available from: www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017).

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