Active surveillance for prostate cancer: Is it ready for primetime in the Caribbean?

In this paper we discuss the strategy of active surveillance (AS) as a whole followed by the implications of its use in the Caribbean. The literature was reviewed with a view to establishing the merits of AS and to identify potential pitfalls in the application of AS among a primarily black population. Active surveillance (AS) has emerged as a viable treatment strategy aimed at reducing overtreatment of indolent disease. However, there have been concerns raised over the applicability of AS among men of African descent. Black men are at higher risk of aggressive disease and data are emerging which suggest outcomes may not parallel those of their white counterparts. Recent advances such as multiparametric MRI and genetic testing have the potential to guide decision making in these men. Active surveillance should not be universally rejected in black men and perhaps further study is needed to determine race-specific recommendations. Until then, discussion with the patient should reflect the potential pitfalls for black men on active surveillance.