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Localized Prostate Cancer: Treatment Options
Stephen Brawley1, Ravinder Mohan1, Christopher D Nein1
1Eastern Virginia Medical School, Portsmouth, VA, USA.
American Family Physician
|September 15, 2018
Summary
Prostate cancer is common but often localized. Treatment options like radical prostatectomy or radiation therapy are available for high-risk cases, while active surveillance suits low-risk patients.
Area of Science:
- Oncology
- Urology
Background:
- Prostate cancer affects 1 in 7 men in the US, with a low mortality rate (1 in 39).
- Early detection often relies on serum prostate-specific antigen (PSA) testing.
Purpose of the Study:
- To outline risk stratification and treatment guidelines for prostate cancer.
- To compare treatment modalities for localized prostate cancer.
Main Methods:
- Risk stratification based on clinical stage, pathologic grade, PSA level, and life expectancy.
- Evaluation of radical prostatectomy, external beam radiation therapy, brachytherapy, and active surveillance.
Main Results:
- Radical prostatectomy and external beam radiation are recommended for high-risk prostate cancer.
- Radical prostatectomy has higher rates of urinary incontinence and erectile dysfunction compared to radiation therapy.
- Brachytherapy is suitable for low-to-intermediate risk disease, and active surveillance for low-risk disease.
Conclusions:
- Treatment decisions for prostate cancer should be individualized based on risk stratification.
- Active surveillance is a viable option for low-risk prostate cancer, involving close monitoring for progression.
- Progression indicators include rising PSA, increasing pathologic grade, or abnormal digital rectal examination.
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