Triggers for Intervention in Men on Surveillance

TL;DRAbstract

The long-term safety and effectiveness of active surveillance depends on our ability to trigger delayed treatment in those men who need it, while avoiding intervention in those who do not. While it would be desirable to come up with precise clinical criteria to serve as triggers for intervention, it is unrealistic to expect the same criteria to apply to all men on surveillance. Rather, the art of surveillance is to identify the most appropriate triggers for each individual patient, as an exercise in shared decision-making. In this chapter, we will review the range of different triggers for intervention that have been proposed, including PSA kinetics, repeat biopsy results and imaging findings, and will discuss their strengths and weaknesses. PSA kinetics are known to be an unreliable trigger. A stable PSA does not exclude significant disease progression, and a rapidly rising PSA does not mean that disease progression is certain. Repeat biopsy results are widely used to indicate the nee

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