Risk stratification and avoiding overtreatment in localized prostate cancer

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Overtreatment of localized prostate cancer (PCa) leads to significant morbidity.
• Risk stratification is crucial for identifying patients who can safely undergo active surveillance.

Purpose of the Study:

• To review current risk stratification tools for localized PCa.
• To assess the safety and efficacy of active surveillance in managing localized PCa.

Main Methods:

• Review of existing literature on risk stratification tools for localized PCa.
• Analysis of data on active surveillance outcomes in patients with very low, low, and favorable intermediate-risk PCa.
• Evaluation of novel biomarkers, multiparametric MRI, and risk calculators in predicting disease progression.

Main Results:

• Active surveillance demonstrates survival and cancer-specific complication rates comparable to immediate treatment for specific PCa risk categories (up to 10-year follow-up).
• Novel biomarkers effectively predict disease upstaging, recurrence, and metastasis.
• Multiparametric MRI accurately detects clinically significant PCa, particularly in biopsy-naïve patients.

Conclusions:

• Current evidence supports active surveillance for carefully selected patients with localized PCa.
• Various tools, including biomarkers and MRI, aid in defining eligibility and supporting active surveillance protocols.
• Further large randomized trials are needed to validate treatment pathways for active surveillance in PCa.