Active surveillance: a review of risk-based, dynamic monitoring

Active surveillance (AS) is an important treatment modality aiming to reduce the overtreatment of patients with prostate cancer (PCa) who have a low risk of disease reclassification. After enrolling in AS patients are actively monitored using different diagnostic tests (e.g., prostate specific-antigen, digital rectal exams (DREs), medical imaging, and prostate biopsies). Biopsy is the most burdensome test. We aimed to review schedules for monitoring men on AS. We compare fixed versus risk based dynamic monitoring, where biopsies are scheduled during follow-up based on dynamic risk predictions. Several prediction models and scheduling techniques have been published. All proposed risk prediction models need further external validation. We conclude that risk based, dynamic monitoring is a promising new strategy to further reduce overtreatment in PCa patients.