Guidelines | Intermediate-risk criteria | Active surveillance recommendations | ||||
PSA (ng/mL) | Pathology | Clinical stage | Favorable intermediate-risk | Candidates for surveillance | Surveillance protocol | |
2018 ASCO[1] | 10-20 | -or- Gleason score 7 | -or- cT2b | Endorses AUA/ASTRO/SUO guidelines | 'Select' favorable intermediate-risk patients, including select patients with low volume, intermediate-risk (grade group 2) localized prostate cancer | PSA every 3 to 6 months, yearly DRE, confirmatory TRUS biopsy within 6 to 12 months and every 2 to 5 years thereafter or more frequently if clinically indicated with consideration of MRI and genomic testing |
2021 EAU/EANM/ESTRO/ESUR/SIOG[2] | 10-20 | -or- Grade group 2 or 3 | -or- cT2b | Not specified | 'Highly selected' intermediate-risk patients with <10% pattern 4 | No schedule specified |
2022 NCCN (v 1.2022)[3] | 10-20 | -or- Grade group 2 or 3 | -or- cT2b/2c | No more than single intermediate-risk factor, grade group 1 or 2, and <50% positive biopsy cores | Favorable intermediate-risk patients | PSA no more than every 6 months and DRE, repeat biopsy, and repeat MRI no more than every 12 months unless clinically indicated |
2022 AUA/ASTRO[4,5] | 10-20 | -or- Grade group 2-3 | -or- cT2b-c | PSA 10-<20 ng/mL and grade group 1, or clinical stage T2b-c and <50% biopsy cores positive or PSA <10 ng/mL with grade group 2 and clinical stage T1-2a and <50% biopsy cores positive | Favorable intermediate-risk patients | No specified surveillance intervals but PSA no more frequently than every 6 months and individualized monitoring regimen based upon estimated risk of recurrence. |
Adapted and updated from: Overland MR, Washington SL 3rd, Carroll PR, et al. Active surveillance for intermediate-risk prostate cancer: yes, but for whom? Curr Opin Urol 2019; 29:605.
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