Low Risk Prostate Cancer and Active Surveillance

Abstract

The first part of this thesis comprises an introduction to prostate cancer and screening (chapter 1). The European Randomized study of Screening for Prostate Cancer (ERSPC) has shown an effect of screening on prostate cancer mortality in favor of the screening population, however, controversies remain. One of the most important side-effects of screening is overdiagnosis with subsequent overtreatment, which has led to the introduction of active surveillance as an alternative to the radical treatment of prostate cancer (chapter 2). With active surveillance, patients with supposedly low-risk tumors receive expectant management and are strictly followed over time. In case of reclassification to higher risk or signs of true disease progression, the patient will switch to deferred radical treatment. Because active surveillance is a relatively new management strategy, its feasibility and the short-term outcomes are the main focus of this thesis (chapter 3). The second part of this thesis focuses on low-risk prostate cancer. In chapter 4 the main findings of the ERSPC are described and the controversial points in prostate cancer screening are discussed, as well as how these issues should be dealt with. Overdiagnosis and overtreatment are indicated as major worries, but less aggressive screening methods, risk modifying calcul