Optimization of follow up in prostate cancer active surveillance

OBJECTIVES: Prostate cancer is a highly prevalent disease but with reduced cause-specific mortality. Active surveillance represents an alternative to postpone or avoid the potential sequelae derived from curative treatments in selected patients. The objective of this article is to review the diagnostic and follow-up methods for patients included in active surveillance programs. METHODS: We performed an exhaustive bibliographic review with the terms "Prostate cancer", "Active surveillance", "expectant management", including the greatest series published since 2007. CONCLUSIONS: Awaiting for genetic markers that help us to predict diagnosis and evolution of prostate cancer, PSA kinetics, digital rectal examination and repeated biopsies continue being the inclusion and follow up criteria for patients in active surveillance programs. Emerging complementary tests such as multi parametric MRI, PCA3 and Phi seem to add specificity to the existing clinical criteria. The reduced number of patients included, the limited follow up and the great disparity of inclusion and follow up criteria between different groups make the implementation of consensus guidelines that could help a more widespread application of this alternative difficult.