The two studies by Hayes1 and Liu2 lend significant importance to urologists, medical oncologists, and radiation oncologists by further offering and discussing the potential benefit of choosing an active surveillance protocol with their patients who have low-risk prostate cancer.

Historical analyses and other empiric opinion have established that in the United States, we underuse the active surveillance option, specifically for patients with low-risk prostate cancer who may never be clinically impacted in their lifetime by their prostate cancer diagnosis. These two articles give further credibility and statistical relevance to the importance of offering active surveillance as a reasonable approach toward monitoring patients with newly diagnosed prostate cancer.

Education Is Key to Understanding Benefits of Active Surveillance

Unfortunately, there are many reasons why the diagnostic physician, who is the first to discuss prostate cancer therapeutic options with the patient, is less inclined to promote and review the importance of active surveillance—specifically with patients at low risk for progression.

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The primary barrier for patients and physicians to better understand and consider active surveillance is education. These articles, as well as others, and ongoing prospective trials further educate our patient and physician populations about the benefit of an active surveillance protocol, insomuch as it avoids unnecessary interventions and their attendant morbidities.

The Teaching Barrier: Overcoming Obstacles

Education about active surveillance can be very complex, for both patients and physicians. There are multiple reasons that vary by specialty, geographical region, and patient community that can create challenges to adequately presenting this alternative approach.

Unfortunately, there may also be legal concerns as well as economic incentives that may lessen the likelihood of a physician offering the active surveillance option.

To overcome the educational barrier, professional and national organizations, as well as device and pharmacology sponsors, must work to improve our societal guidelines and educational efforts. They must further expand the discussion of active surveillance as a therapeutic option.

New Biomarkers Revolutionizing Protocol and Therapy

The discovery and validation of new biomarkers—whether serum, urinary, or histopathologic—will certainly be revolutionary in our ability to more proactively and confidently recommend an active surveillance protocol. In a corollary fashion, they will also assist us in suggesting more aggressive therapy when appropriately indicated.

Neal Shore, MD, FACS, is Director, CPI, at Carolina Urologic Research Center, and Managing Partner at Atlantic Urology Clinics, Myrtle Beach, South Carolina.


1. Hayes JH, Ollendorf DA, Pearson SD, et al. Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis. JAMA. 2010;304(21):2373-2380.

2. Liu D, Lehmann HP, Frick KD, Carter HB. Active surveillance versus surgery for low risk prostate cancer: a clinical decision analysis. J Urol. 2012;187(4):1241-1246.