The Prostate Cancer Intervention versus Observation Trial (PIVOT), initiated in the early era of prostate-specific antigen (PSA) testing, showed that radical prostatectomy did not significantly reduce prostate cancer–specific or overall mortality after 12 years. The Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), a randomized trial of radical prostatectomy versus watchful waiting in men with localized prostate cancer diagnosed before the era of PSA testing, with observation at 15 years of follow-up showed that reduction of prostate cancer specific mortality after radical prostatectomy was largest in men younger than 65 years of age.
　Aggressive treatment for lower-risk prostate cancers may result in overtreatment for indolent cancer. Furthermore all kinds of treatment may jeopardize the quality of life of patients.??
Active surveillance (AS) has been introduced as an observational strategy to delay or avoid curative treatment without compromising long?term cancer?specific survival. This strategy may help to reduce treatment-associated morbidity and medical cost. It is extremely important for country such as Taiwan.
A national survey showed most prostate cancer specialists in the United States believe AS effective and underused for low-risk prostate cancer, yet continue to recommend the primary treatments their specialties deliver. I believe this phenomenon is also existed in Taiwan. Increased attention to education at the time of the diagnosis may help alleviate distressed patients who are concerned about risks of progression and the intensity of diagnostic testing from undergoing AS. It may also alleviate distress from physicians.