Aligning evidence and practice: Future research needs to increase utilization of active surveillance for favorable risk prostate cancer

Purpose of review The prolonged natural history of prostate cancers detected through prostate-specific antigen-based testing has resulted in many men today undergoing treatment for prostate cancer that will not improve health outcomes. Active surveillance is an underutilized approach to reducing overtreatment of favorable risk prostate cancer. This review outlines the areas for future research that could improve the uptake of active surveillance as a management option. Recent findings The reasons for limited uptake of active surveillance for favorable risk prostate cancer are multifactorial and complex. The variability in management of favorable risk disease among older men can be attributed to a greater extent to the individual physician rather than tumor and patient characteristics. Increased uptake of active surveillance will depend on improved risk stratification at diagnosis, surveillance protocol standardization, and patient decision support that accounts for individual patient preferences. Summary The disconnect between evidence and practice with respect to management of favorable risk prostate cancer has resulted in overtreatment. Active surveillance as a management option for favorable risk disease may become more acceptable to patients and physicians as research needs are met.