[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-337638-105":59,"doc-detail-337638-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","shifting-the-paradigm-in-the-management-of-early-prostate-cancer","Shifting the paradigm in the management of early prostate cancer","","Commentary on early prostate cancer management argues that outcomes from active surveillance show it is optimal for many early cases, yet training and healthcare systems remain focused on immediate treatment. It discusses how earlier disease states lack standard nomenclature across countries and guidelines, outlines how modern AS monitors PSA via regular blood tests, interval MRI, and repeat biopsies when indicated, and emphasizes patient-centered counseling considering competing mortality and long-term cancer trajectories.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/shifting-the-paradigm-in-the-management-of-early-prostate-cancer/337638/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/shifting-the-paradigm-in-the-management-of-early-prostate-cancer/337638.png","ImageObject",300,407,{"name":92,"@type":93},"Ava Thompson","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-23","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why does the commentary say active surveillance should be the optimal option for many early prostate cancers?","Question",{"text":112,"@type":113},"It states that outcomes from active surveillance clearly show it is optimal for managing many early prostate cancers, and that it has strong evidence for Cambridge Prognostic Group 1 and supports careful surveillance protocols for CPG2 disease.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does modern active surveillance monitor patients with early prostate cancer?",{"text":117,"@type":113},"Modern AS uses a schedule of regular blood tests for PSA, interval MRI scans, and repeat prostate biopsies if indicated, aiming to avoid over-treatment of cancers unlikely to cause harm.",{"name":119,"@type":110,"acceptedAnswer":120},"What problem does the commentary raise about terminology for earlier prostate cancer states?",{"text":121,"@type":113},"It notes that clinicians understand locally advanced or metastatic prostate cancer definitions, but nomenclature for earlier states is less well defined and varies by country and guideline.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},337638,1790142420,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39},1649267921044,"https://us-avatar.wpscdn.com/avatar/1800007509477c92dfb?_k=1786009248482753345","British Journal of Cancer [www.nature.com/bjc](www.nature.com/bjc)  \nCOMMENT OPEN   \nClinical Studies  \nShifting the paradigm in the management of early prostate cancer  \n 1,2 ✉  \nVincent Gnanapragasam   \n© The Author(s) 2024  \n|  |  |  |\n| --- | --- | --- |\n|  | Outcomes from active surveillance have clearly shown that it is the optimal method of managing many early prostate cancers. Yet, clinician training and healthcare systems are still primarily focused on the “need to treat”. This comment explores the challenges |  |\n|  |  |  |\n|  |  |  |\n| and resource issues in future implementation of high-quality surveillance programmes. |  |  |\n|  | British Journal of Cancer (2024) 130:1075–1077; [https://doi.org/10.1038/s41416-024-02641-7](https://doi.org/10.1038/s41416-024-02641-7) |  |\n|  |  |  |\n\nCOMMENTARY  \nClinicians implicitly understand the definitions of locally advanced or metastatic prostate cancer, however the nomenclature for earlier disease states is not as well defined and differ depending on the country and guideline used. This is becoming increasingly important as many men will now present with prostate cancer that could be classified as “early”. The 25-year-old terminology of“risk” (based on biochemical relapse after surgery or radiotherapy) is no longer relevant or suitable in the context of modern disease management [1] .  \nPerhaps one unifying theme across guidelines is that early cancers are those considered suitable for active surveillance (AS) as either a preferred or an equal option for management.  \nAS is a programme of monitoring prostate cancer that is considered to have a very low chance of metastasis and/or causing death. Modern AS involves a schedule of regular blood tests to monitor the Prostate Specific Antigen levels (PSA), interval MRI scans of the prostate and repeat prostate biopsies if indicated. The aim is to avoid over-treatment of cancers that are unlikely to cause harm in a patient’s natural lifetime. In the UK, NICE have defined cancer suitable for AS as those classified as NICE Cambridge Prognostic Groups (CPG) 1 and 2 ([https://](https://)[ ](https://)[www.nice.org.uk/guidance/ng131](www.nice.org.uk/guidance/ng131)) (outside the UK the terms “lowrisk” and “favourable-intermediate risk” continue to be used and correspond approximately to CPG1 and CPG2) . It is estimated that up to 1 in 3 men are diagnosed with CPG1/2 prostate cancer and potentially suitable for AS every year in England alone (approx. 20- 25,000 men/year) [2] .  \nUnderstanding of the long lead times of early cancer trajectories is now clearer with the reporting of seminal longterm observation and randomised control studies [3, 4] . These have shown equivalence of immediate intervention versus surveiilance in survival rates but continue to generate strong views for and against treatment; usually depending on the skillset  \nof the proponent. This long natural history has arguably also helped underpin the genesis of “lesion only” ablative therapies which have so far shown better functional outcomes but not improved survival outcomes. The same long natural history mandates the more critical question of whether early cancers need any treatment at all at the time of diagnosis.  \nIn the past decades AS has moved from the fringes of prostate cancer management into primetime; becoming in its own right an expanding and increasingly complex area of clinical management. Outcomes from active surveillance have clearly shown that it is the optimal method of managing CPG1 prostate cancer and there is strong evidence that CPG2 disease can equally be well managed with surveillance, although with more careful protocols. Where once research and discovery focused on surgical, radiotherapy or other intervention outcomes, AS now has its own rapidly growing literature on biomarkers, imaging, clinical protocols, criteria, intervention trials and artificial intelligence technologies. Indeed, the management of early prostate cancer represents the quintesse","cbCaiseSORr2q5fe","https://ap.wps.com/l/cbCaiseSORr2q5fe","pdf",274304,"English","# COMMENTARY\n## Active surveillance as the preferred management\n## Nomenclature and risk terminology across guidelines\n## AS monitoring program and surveillance criteria","[{\"question\":\"Why does the commentary say active surveillance should be the optimal option for many early prostate cancers?\",\"answer\":\"It states that outcomes from active surveillance clearly show it is optimal for managing many early prostate cancers, and that it has strong evidence for Cambridge Prognostic Group 1 and supports careful surveillance protocols for CPG2 disease.\"},{\"question\":\"How does modern active surveillance monitor patients with early prostate cancer?\",\"answer\":\"Modern AS uses a schedule of regular blood tests for PSA, interval MRI scans, and repeat prostate biopsies if indicated, aiming to avoid over-treatment of cancers unlikely to cause harm.\"},{\"question\":\"What problem does the commentary raise about terminology for earlier prostate cancer states?\",\"answer\":\"It notes that clinicians understand locally advanced or metastatic prostate cancer definitions, but nomenclature for earlier states is less well defined and varies by country and guideline.\"}]","Shifting the paradigm in the management of early prostate cancer | PDF",1790019947]