There is no convincing medical evidence that any one treatment results in better survival compared to the others. Therefore, the best treatment is the one with the least side effects. Focusing on the potential side effects of treatment is paramount since they can be permanent. Therefore, since there is no obvious best choice, the “right” treatment is the last option left on the list after all the other less desirable treatment choices have been ruled out.
Active surveillance can also be considered under certain circumstances. At the 2007 consensus conference on active surveillance the line of demarcation between Sky and Teal was determined by the consensus of a number of experts, not by a prospective study. Therefore, the men in Teal who are barely “over the line,” i.e., their parameters are close to Sky may want to consider active surveillance. Men over 70 may also be candidates for active surveillance.