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Background <p>In localized low- and intermediate-risk prostate cancer, treatment decisions require balancing the avoidance of overtreatment against timely curative intervention for clinically relevant disease. Active surveillance is an established strategy for appropriately selected patients with low-risk prostate cancer, whereas definitive treatment may be indicated in patients with unfavorable risk features.</p> Objective <p>This review aims to summarize decision-making between active surveillance and active treatment in low- and intermediate-risk prostate cancer, considering modern risk stratification, diagnostic tools, and urological as well as radiation oncology treatment options.</p> Materials and methods <p>This article is based on a&#xa0;selective literature review and an evaluation of current guidelines and relevant studies on risk classification, active surveillance, radical prostatectomy, and definitive radiotherapy in localized prostate cancer.</p> Results <p>Treatment decisions are mainly based on prostate-specific antigen (PSA) level, clinical tumor stage, International Society of Urological Pathology (ISUP)/Gleason grade group, tumor burden, multiparametric MRI findings, PSA density, and adverse histopathological features such as cribriform or intraductal growth patterns. Active surveillance is the standard approach for selected patients with low-risk prostate cancer and may be considered on an individual basis in favorable intermediate-risk disease. In patients with unfavorable intermediate-risk disease, histological upgrading, or radiological or clinical progression, definitive treatment should be discussed. Radical prostatectomy and modern radiotherapy are established curative treatment options with distinct functional side-effect profiles.</p> Conclusion <p>The choice between surveillance and active treatment requires individualized, interdisciplinary assessment of tumor biology, life expectancy, comorbidities, functional risks, and patient preferences.</p>

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Active Surveillance versus aktive Therapie beim Low- und Intermediate-Risk-Prostatakarzinom

  • 期刊论文

  • 发表日期：

    2026年7月24日

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  • Ruth Himmelsbach,
  • Maximilian Filzmayer,
  • Christian Gratzke,
  • Felix Chun,
  • Simon K. B. Spohn,
  • August Sigle

摘要

Background

In localized low- and intermediate-risk prostate cancer, treatment decisions require balancing the avoidance of overtreatment against timely curative intervention for clinically relevant disease. Active surveillance is an established strategy for appropriately selected patients with low-risk prostate cancer, whereas definitive treatment may be indicated in patients with unfavorable risk features.

Objective

This review aims to summarize decision-making between active surveillance and active treatment in low- and intermediate-risk prostate cancer, considering modern risk stratification, diagnostic tools, and urological as well as radiation oncology treatment options.

Materials and methods

This article is based on a selective literature review and an evaluation of current guidelines and relevant studies on risk classification, active surveillance, radical prostatectomy, and definitive radiotherapy in localized prostate cancer.

Results

Treatment decisions are mainly based on prostate-specific antigen (PSA) level, clinical tumor stage, International Society of Urological Pathology (ISUP)/Gleason grade group, tumor burden, multiparametric MRI findings, PSA density, and adverse histopathological features such as cribriform or intraductal growth patterns. Active surveillance is the standard approach for selected patients with low-risk prostate cancer and may be considered on an individual basis in favorable intermediate-risk disease. In patients with unfavorable intermediate-risk disease, histological upgrading, or radiological or clinical progression, definitive treatment should be discussed. Radical prostatectomy and modern radiotherapy are established curative treatment options with distinct functional side-effect profiles.

Conclusion

The choice between surveillance and active treatment requires individualized, interdisciplinary assessment of tumor biology, life expectancy, comorbidities, functional risks, and patient preferences.