Indications for and transitioning to secondary treatment while on active surveillance for prostate cancer

For men with lower risk prostate cancer, there is ever-growing literature that demonstrates the oncologic safety of deferring radical treatment and opting for regular monitoring for disease progression. This strategy's success is largely owed to appropriate, systematic monitoring protocols that typically employ various prostate specific antigen (PSA) metrics or digital rectal exam (DRE) findings. Novel biologic markers and advanced imaging techniques have shown promise in active surveillance (AS) populations such as for use of patient candidacy as well as detection of disease progression. This review summarizes contemporary surveillance protocols as well as the emerging technologies which demonstrate significant potential to improve such protocols.