Genomic scores are independent of disease volume in men with favorable risk prostate cancer—implications for choosing men for active surveillance

For low-risk prostate cancer, active surveillance (AS) has been increasingly proposed as the preferential initial management strategy. AS entails a strategy by which selected men are managed expectantly with the intention to apply potentially curative treatment in case of progression signs (1). Progression mainly occurs during the 2 first years with differed treatment rates ranging from 20% to 40% among prospective series (1,2). This “rapid” progression could be explained by a not ideal initial selection rather than a real pathological progression of truly very low risk prostate cancer. Thus, for treatment decisions and inclusion of patients in AS protocols, clinicians have to deal with this clinically meaningful risk of reclassification (3-5)