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Innovations in Active Surveillance Management of Early Prostate Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Epidemiology and Prevention".

Deadline for manuscript submissions: 8 August 2026 | Viewed by 2420

Special Issue Editor


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Guest Editor
1. Cambridge Prostate Cancer Research and Clinical Trials Group, Cambridge, UK
2. Department of Surgery, University of Cambridge, Cambridge, UK
3. Department of Urology, Cambridge University Hospitals, Cambridge, UK
Interests: prostate cancer; risk stratification; active surveillance; prognostic markers; translational research

Special Issue Information

Dear Colleagues,

Prostate cancer is the most common cancer diagnosed in the West and the second most common male cancer globally. The majority of diagnosed men, however, will live with rather than die from prostate cancer. For many men, treatment may in fact only bring harm without any tangible survival benefit. Active surveillance is a disease management strategy that monitors early prostate cancer with a low probability of ever causing harm in a patient’s natural lifetime. In modern PSA-detected prostate cancer populations, up to a quarter of men diagnosed may be eligible for active surveillance.

Despite its importance as a management option in clinical practice, most academic literature on active surveillance is based on data extrapolated from other treatments or from expert/consensus opinion. In this Special Issue of Cancers, we seek to address this evidence gap by highlighting research that has been based on investigating cohorts of men on surveillance and in whom clinic-pathological features, prediction tools, imaging, or biomarkers have been tested and explored. We particularly welcome articles that look at the natural history of early cancers, methods for risk-adapted surveillance, and tools that may detect progression to a clinically meaningful endpoint. We look forward to receiving your submissions.

Prof. Dr. Vincent J. Gnanapragasam
Guest Editor

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Keywords

  • prostate cancer
  • risk stratification
  • active surveillance
  • predictive markers
  • personalized management
  • imaging
  • biomarkers
  • clinical pathways
  • patient outcomes
  • standardizing care
  • attrition
  • cohort studies

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Published Papers (2 papers)

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Research

11 pages, 234 KB  
Article
PSMA PET in Active Surveillance: Initial Experiences and Future Directions
by Jonathon Carll, Jordan Santucci, Sarah Whitty, Jacinta Bonaddio, Marlon Perera, Dixon Teck Sing Woon, Mark Frydenberg and Nathan Lawrentschuk
Cancers 2026, 18(9), 1376; https://doi.org/10.3390/cancers18091376 - 26 Apr 2026
Viewed by 817
Abstract
Background/Objectives: We conducted an exploratory review of patients in our institutions who had undergone a PSMA PET/CT whilst on active surveillance, determining patient characteristics and trends. Methods: A retrospective cohort study of patients who were on active surveillance for low or [...] Read more.
Background/Objectives: We conducted an exploratory review of patients in our institutions who had undergone a PSMA PET/CT whilst on active surveillance, determining patient characteristics and trends. Methods: A retrospective cohort study of patients who were on active surveillance for low or favourable intermediate-risk prostate cancer and had a PSMA PET/CT done due to the presence of risk factors was performed. Risk factors that were an indication for PSMA PET/CT were: The presence of ISUP GG 2 disease, or ISUP GG1 disease with a PSA > 10 or a PI-RADS score of 4 or 5 on their MRI. Results: We identified 45 patients who underwent PSMA PET/CT whilst on active surveillance. Of these patients, 14 remained on active surveillance at the time of review, whilst 31 had progressed to definitive treatment. There was a significantly different distribution of PRIMARY scores between these two groups, although the average SUVMax was similar. In our practice, we found PSMA PET/CT to be particularly useful when performing confirmatory biopsies on patients who had normal MRI scans or were unable to go for the MRI at the time of diagnosis. Conclusions: PSMA PET/CT shows promise as a tool for active surveillance, particularly in men with risk factors for progressing to active treatment. However, our cohort was too small to draw definitive conclusions, and further research is needed. Full article
13 pages, 2279 KB  
Article
Application of the STRATCANS Criteria to the MUSIC Prostate Cancer Active Surveillance Cohort: A Step Towards Risk-Stratified Active Surveillance
by Ana M. Moser, Michael Wang, Ava Zamani, Sabir Meah, Stephanie Daignault-Newton, Corinne Labardee, Nicholas Dybas, Jacob Clapper, Brian R. Lane, Tudor Borza, Alice Semerjian, Vincent J. Gnanapragasam and Kevin B. Ginsburg
Cancers 2025, 17(18), 3032; https://doi.org/10.3390/cancers17183032 - 17 Sep 2025
Cited by 1 | Viewed by 1279
Abstract
Background: The STRATified CANcer Surveillance (STRATCANS) model risk-stratifies patients with prostate cancer (PC) on active surveillance (AS) into three tiers based on their risk of disease progression. We applied STRATCANS to the Michigan Urological Surgery Improvement Collaborative (MUSIC) Prostate registry to assess its [...] Read more.
Background: The STRATified CANcer Surveillance (STRATCANS) model risk-stratifies patients with prostate cancer (PC) on active surveillance (AS) into three tiers based on their risk of disease progression. We applied STRATCANS to the Michigan Urological Surgery Improvement Collaborative (MUSIC) Prostate registry to assess its association with the risk of biopsy upgrading and time to definitive treatment in a diverse, real-world AS cohort. Methods: We retrospectively reviewed the MUSIC registry for PC patients on AS from 2016 to 2022 and classified patients by STRATCANS tier. Primary outcomes included biopsy upgrading to ≥Grade Group 3 (≥GG3), any biopsy upgrading, and time to definitive treatment. Results: Among 7578 men on AS, 4009, 2732, and 837 patients were in STRATCANS 1, 2, and 3, respectively. The risk of progression to ≥GG3 was 13%, 33%, and 53% for patients in STRATCANS 1, 2, and 3, respectively (p < 0.001). The rate of any biopsy upgrading was approximately 50% at 3 years across all STRATCANS tiers. STRATCANS tiers were also significantly associated with time to definitive treatment, with 16%, 28%, and 35% of men in STRATCANS 1, 2, and 3, respectively, receiving definitive treatment by 36 months. Limitations include confounding inherent to retrospective registry studies, a short 60-month follow-up period, and variability in biopsy method with no centralized pathology and radiology review. Conclusions: STRATCANS has a stepwise association with the risk of progression to ≥GG3 disease and time to definitive treatment among men on AS in the MUSIC cohort, supporting its use as a risk-based, follow-up approach in men on AS. Full article
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