American Board of Internal Medicine (ABIM) Certification Practice Exam

For which group of prostate cancer patients is active surveillance appropriate?

1. Patients with high-risk prostate cancer

2. Patients with very low-risk or low-risk prostate cancer with a life expectancy of at least 10 years

3. All patients with prostate cancer

4. Patients with metastatic prostate cancer

The correct answer is: Patients with very low-risk or low-risk prostate cancer with a life expectancy of at least 10 years

Active surveillance is particularly appropriate for patients with very low-risk or low-risk prostate cancer and a life expectancy of at least 10 years. This approach allows for the monitoring of cancer without immediate intervention, which is beneficial for patients who have tumors that are not aggressive and for whom the risk of progression is low. The rationale for this strategy is to avoid the potential adverse effects of overtreatment — such as surgery or radiation — which can significantly impact the quality of life. In the context of prostate cancer, patients classified as very low-risk or low-risk typically have favorable prognostic factors, including low Gleason scores, low PSA levels, and small tumor volumes, indicating a lower likelihood of disease progression. If these patients also have a longer life expectancy, the potential benefits of active surveillance—such as preserving quality of life and avoiding unnecessary treatments—outweigh the risks, given that the cancer is unlikely to become life-threatening in the near term. High-risk patients typically require more aggressive treatment due to their increased likelihood of disease progression. Similarly, patients with metastatic prostate cancer usually need immediate treatment rather than surveillance because their disease is more advanced and poses a greater threat. Active surveillance is not a viable option for all patients with prostate cancer, as it is specifically tailored for