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To treat or not to treat: is the way forward clearer in low‐risk prostate cancer?

The recent Prostate Cancer Intervention Versus Observation Trial (PIVOT) has reported that for men with low-risk prostate cancer (LRPC) radical prostatectomy (RP) conveys no benefit compared with surveillance alone. These results add to the growing body of evidence that most men with low-risk disease will not benefit from active treatment; however, there are major issues to consider before there can be widespread adoption of active surveillance (AS). The present editorial considers the shortcomings in current methods of grading and staging prostate cancer and of being able to robustly assign risk. It also discusses the implications of widespread adoption of AS and the effects on resources and for health services. Finally, it highlights the urgent need for debate and consensus on defining the criteria and mechanism of an AS programme and the fact that these need to be determined before a radical change in management of low-risk disease is implemented.