{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:46:20Z","timestamp":1792007180353,"version":"4.4.0"},"reference-count":48,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Low-risk prostate cancer (PCa) has historically been overtreated, exposing men to unnecessary morbidity. Emerging evidence supports conservative management of low-risk PCa without immediate radical intervention. Contemporary data show a marked decline in surgical overtreatment, with the proportion of radical prostatectomies yielding only Grade Group 1 cancers falling from 32.4% in 2010 to 7.8% in 2020 in the US SEER registry. Long-term studies confirm that deferring treatment is safe for low-risk disease, with PCa-specific survival exceeding 95% at 15\u201325 years for cohorts managed with surveillance. Major guidelines now endorse active surveillance (AS) as the preferred management for low-risk PCa. An alternative risk stratification system that expands the low-risk category was shown to reclassify 45\u201383% more men as low risk without increasing 15-year PCa mortality. Focal therapy has emerged as a potential middle-ground strategy, though evidence is still limited. The paradigm for managing low-risk PCa has shifted toward conservatism, with AS firmly established as the standard of care. Continued efforts to refine risk stratification and evaluate focal therapy are needed to further optimize individualized care, minimize harm, and maintain excellent cancer-specific outcomes for low-risk PCa. This comprehensive review aims to create a practical, risk-adapted framework for managing patients on AS. We will: (i) summarize inclusion criteria and outcomes, (i) compare AS follow-up schedules across major institutions and guidelines, (iii) provide evidence-based criteria to de-intensify surveillance in men with sustained stability and (iv) clarify the role of focal therapy as an intermediate treatment option within the AS continuum.<\/jats:p>","DOI":"10.3390\/diagnostics16091310","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:24:51Z","timestamp":1777317891000},"page":"1310","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Beyond One-Size-Fits-All Active Surveillance for Low-Risk Prostate Cancer: Risk-Adapted Follow-Up, De-Escalation Pathways, and Focal Therapy as Tailored Strategy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4178-373X","authenticated-orcid":false,"given":"Fabio","family":"Zattoni","sequence":"first","affiliation":[{"name":"Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9070-5706","authenticated-orcid":false,"given":"Andrea","family":"Mari","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence\u2014Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo Giovanni","family":"Falagario","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institute, SE-171 76 Stockholm, Sweden"},{"name":"Department of Urology, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0260-4601","authenticated-orcid":false,"given":"Riccardo Giuseppe","family":"Bertolo","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Verona, A.O.U.I., 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Albisinni","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5425-5453","authenticated-orcid":false,"given":"Daniele","family":"Amparore","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Turin, Orbassano, 10043 Turin, Italy"},{"name":"Division of Urology, Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo (TO), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7321-1536","authenticated-orcid":false,"given":"Lorenzo","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5237-0888","authenticated-orcid":false,"given":"Riccardo","family":"Campi","sequence":"additional","affiliation":[{"name":"Unit of Urology and Renal Transplantation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy"},{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7011-0537","authenticated-orcid":false,"given":"Roberto","family":"Contieri","sequence":"additional","affiliation":[{"name":"Department of Urology, Istituto Nazionale Tumori \u201cFondazione Pascale\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5961-9874","authenticated-orcid":false,"given":"Elisa","family":"De Lorenzis","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS Foundation C\u00e0 Granda\u2014Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2771-2919","authenticated-orcid":false,"given":"Paolo","family":"Dell\u2019Oglio","sequence":"additional","affiliation":[{"name":"Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-4127","authenticated-orcid":false,"given":"Michele","family":"Marchioni","sequence":"additional","affiliation":[{"name":"UniCamillus\u2014Saint Camillus International University of Health Sciences, 00131 Rome, Italy"},{"name":"Department of Urology, Leonardo Foundation, 35037 Abano Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5169-3631","authenticated-orcid":false,"given":"Veronica","family":"Mollica","sequence":"additional","affiliation":[{"name":"Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Moschini","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Soria","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Sciences\u2014San Giovanni Battista Hospital, University of Studies of Torino, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Talso","sequence":"additional","affiliation":[{"name":"ASST Fatebenefratelli\u2014Sacco, Ospedale Fatebenefratelli, 20121 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Turri","sequence":"additional","affiliation":[{"name":"Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9621-3059","authenticated-orcid":false,"given":"Savio Domenico","family":"Pandolfo","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"},{"name":"Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1016\/S0140-6736(24)00651-2","article-title":"The Lancet Commission on prostate cancer: Planning for the surge in cases","volume":"403","author":"James","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1056\/NEJMoa2503223","article-title":"European Study of Prostate Cancer Screening\u201423-Year Follow-up","volume":"393","author":"Roobol","year":"2025","journal-title":"N. 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