Active surveillance versus nonradical treatment for low-risk men with prostate cancer: a review

Low-risk prostate cancer has traditionally seen a preference towards avoiding treatment-related harms with active surveillance (AS) and multimodal monitoring protocols utilized to assess for disease progression. Large trials have shown variations in mortality and cancer survival benefit between AS and radical treatment, which has prompted further trials into the management of low-risk disease. Nonradical treatments for men on AS have been an emerging field and yet to enter mainstream guidelines or practice. These include pharmacological treatments, focal therapy, nutraceuticals, immunotherapy, and exercise. We present a review of all current major randomized clinical trials for nonradical treatment of men on AS and summarize their findings.