Clinically insignificant prostate cancer. Modern tactics of therapy options choice

Prostate cancer (PCa) - one of the most common diseases among the male population of the world, providing a major impact on world health and economy. It is believed that the disease within the first 15 years after detection is relatively indolent, and a significant increase in mortality rates is observed after 15 years. High popularity of screening led to overdiagnosis, ie, the detection of clinically insignificant prostate cancer. Due to modern practices active treatment of PCa is a gold standard, however any option can cause such complications as sexual and voiding dysfunction, which leads to a decrease of quality of life. Active surveillance in patients with clinically insignificant PCa is one of the main option. This option has social, psychological and economic advantages. However we should be aware of serious drawbacks of such option and bear in mind psychological and social aspects of the patient. To date there is no reliable data on the natural history of prostate cancer and its consequences. Also no standards and criteria for active surveillance and switch for active treatment are determined. In view of the above there is an obvious need of research of indications, contraindications, active surveillance duration, criteria of a switch to active treatment, that should lead to optimization of treatment in this patient group in future.