Klotz L, et al. – Researchers conducted a clinical study which indicated that patients with intermediate–risk prostate cancer (PCa) should not be excluded from active surveillance based on a single criterion. It was demonstrated that treatment decisions should be based on multiple parameters, including percent Gleason 4, PSA density, cancer volume on biopsy, magnetic resonance imaging findings, and patient age and co–morbidity. Genetic tissue–based biomarkers are also likely to play a role in enhancing decision making.

• In this analysis, outcome findings for intermediate-risk patients managed by active surveillance illustrate reasonable outcomes, but these men clearly are at higher risk for progression to metastatic disease.
• It was considered that the use of biomarkers and multiparametric MRI will enable a more precise and personalized risk assessment.
• Moreover, literature describing the impacts of young age on outcomes is limited, but the experience reported in prospective series with 15–20 year follow-up suggests it is a safe approach.
• In addition, African-American men are at greater risk for occult co-existent higher-grade disease, but in the absence of this their outcome is favorable.