21].

While there is solid evidence that the uptake of AS is increasing in the United States, such data are scarce in Europe, mainly due to the lack of a centralized data reporting system for patients diagnosed with PCa [72]. Nordic countries have historically relied on solid nationwide databases that can help answer the question of how many patients with low-grade PCa are managed with AS. In a recent population-based study in Sweden, more than 90% of patients with very low-risk PCa and more than 70% of those with low-risk PCa were initially managed with AS from 2011 to 2014 [6]. Further evidence from the Danish Prostate Registry, another solid nationwide database, shows similar rates of uptake of AS for men with GG 1 PCa [73]. Of note, both Swedish and Danish gures are simi­lar to the proportion and trend of men initially managed with AS in the United States [72]. Considering that FT indications varied in the last decade, and current guidelines consider this approach experimental, there is no solid data on the uptake of this form of treatment worldwide. For the same reason, since monitoring strategies after delivery differ at an institutional level, it is difcult to determine rates of adherence, as well the rates of treatment failure, in patients treated with FT. It is established that long-term onco­logic outcomes after AS are excellent, with almost no patients dying of PCa and very few developing distant metastases [8, 16]. Long­term outcomes of FT are not yet established since many patients may undergo repeated FT sessions, and eventually receive any form of radical salvage treatments, such as RP and RT [50, 53]. Nonetheless, approximately 25–50% of patients with low-, intermediate-, or high-risk PCa had a failure at a 5-year follow-up in two large UK cohorts, with failure dened as a tran­sition to salvage whole-gland treatment, metas­tases, or PCa mortality [50, 53]. When considering only the transition to radical forms of treatment, less than 20% were treated after FT delivery in a UK cohort [50]. Of note, there are overlaps of monitoring strategy after FT