Most of the prostate cancers diagnosed with a PSA or screening tests are early stage cancers. A significant portion of these cancers are clinically insignificant. Active treatment in prostate cancer also harbors important risks and complications. The aim of active surveillance is to correctly define patients who are candidates and prevent them from unnecessary treatment. Only relying on PSA and biopsy parameters for choosing these patients have many limitations. Estimation of tumor volume and Gleason scoring is not precise in biopsy. In this group of patients missing the window for cure of the disease is a major concern. Patient selection criteria, rebiopsy protocol for the selected patients, surveillance schemes and criteria for abandoning active surveillance should be clarified.