Prostate cancer

Active surveillance: yes or no?

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Educational Objective: Be able to assess if a patient is a good candidate for active surveillance or not.
Specialty: Urology, Radiation oncology
Target Audience: CME (basic), Residents (senior)
Latest update: January 2022

Overdiagnosis of indolent PCa still is prevalent due to PSA testing and often leads to overtreatment. A lot of men eligible for active surveillance according to international guidelines do receive radical therapy.

The cases included in this topic were all diagnosed based on systematic 12-core biopsies, without targeted biopsies. The EAU guidelines strongly recommend to perform multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy. In case mpMRI is positive (i.e. PI-RADS >3), it is strongly recommended to combine targeted and systematic biopsy. However, systematic biopsy is an acceptable approach in case MRI is unavailable [1]. We are currently developing cases for whom the ‘MRI first’ pathway is followed, so stay tuned for new cases.

  1. Mottet N, Cornford P, van den Bergh RCN, et al. EAU – EANM – ESTRO – ESUR – ISUP – SIOG guidelines on prostate cancer. Update 2021. Available at: