Management of early-stage prostate cancer

Prostate cancer is the second most common cancer diagnosed in men, with a median age of diagnosis of 66 years. Early disease is often asymptomatic, and diagnosis is based on abnormal prostate specific antigen (PSA) levels followed by a transrectal ultrasound-guided biopsy, digital rectal exam, or both. Disease staging after diagnosis is used to evaluate prognosis and determine the treatment approach. Biomarkers are useful for prostate cancer screening and as prognostic factors. The most important biomarker is PSA; however, newer prognostic factors may be more specific for prostate cancer. The goal of treatment is to identify patients who are most likely to benefit from therapy while minimizing treatment-related complications. Treatment options include watchful waiting/ active surveillance, radical prostatectomy, external beam radiation therapy, brachytherapy, cryotherapy, androgen deprivation therapy, and combination therapy. Additional studies to evaluate comparative effectiveness and cost-effectiveness of therapies would be beneficial, as availability of these data are limited.