Active surveillance (AS) represents a paradigm change in the management of low-risk prostate cancer. In appropriately selected patients, AS has been demonstrated to reduce the over-treatment of indolent prostate cancers with improvement in quality of life (QOL) with the caveat that the diagnosis of lethal malignancies remain feasible while the cancer remains curable. 1,2 Multiple AS studies have documented prostate cancer specific survival rates of 94-99.9% at 15 years with non-prostate cancer deaths being 9-24 times more likely. 3,4 AS protocols are hampered by a lack of consensus regarding standardized criteria for inclusion, follow-up, and the initiation of therapeutic intervention. 3-5 In particular, definitive local therapy is often recommended to healthy younger men with low-risk features due to a