Risk stratification and avoiding overtreatment in localized prostate cancer

Bishoy Hanna, Weranja Ranasinghe, Nathan Lawrentschuk

Research output: Contribution to journalReview ArticleResearchpeer-review

3 Citations (Scopus)


Purpose of reviewSignificant morbidity is associated with overtreatment of clinically localized prostate cancer (PCa). Risk stratification tools such as novel biomarkers, MRI and risk calculators are useful in predicting which patients would benefit from active surveillance. This review examines current risk stratification tools in localized PCa and the safety of active surveillance in these patients.Recent findingsVery low risk, low-risk and favourable intermediate-risk PCa variants may benefit from treatment with active surveillance. These disease categories have been shown (with up to 10-year follow-up) to have survival and cancer-specific complication rates similar to immediate definitive treatment. Novel biomarkers sensitively predict upstaging, recurrence and metastatic progression while multiparametric MRI reliably detects clinically significant PCa and is valuable in the biopsy naïve patient considering active surveillance. Lastly, risk calculators and nomograms are being developed to combine clinical data and provide optimal individualized treatment while minimizing overtreatment in clinically localized disease.SummaryAlthough large randomized trials are needed to validate treatment pathways, current data supports active surveillance in certain clinically localized PCa. Many tools exist to define and support active surveillance in this group.

Original languageEnglish
Pages (from-to)612-619
Number of pages8
JournalCurrent Opinion in Urology
Issue number6
Publication statusPublished - Nov 2019
Externally publishedYes


  • favourable intermediate risk
  • low risk
  • multiparametric MRI
  • nomograms
  • novel biomarkers
  • risk calculators
  • risk stratification
  • very low risk

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