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Intermediate-risk Prostate Cancer: Stratification and Management.

Felix Preisser1, Matthew R Cooperberg2, Juanita Crook3

  • 1Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.

European Urology Oncology
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Intermediate-risk prostate cancer treatment is complex due to patient heterogeneity. This review examines evidence for stratification and treatment options, including active surveillance, surgery, and radiotherapy, to guide clinical decisions.

Keywords:
Active surveillanceFocal therapyProstate cancerRadical prostatectomyRadiotherapy

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Area of Science:

  • Oncology
  • Urology
  • Cancer Research

Background:

  • Intermediate-risk prostate cancer presents a heterogeneous patient group, complicating uniform treatment recommendations.
  • Variable prognoses within this cohort necessitate refined stratification and management strategies.

Purpose of the Study:

  • To comprehensively review the current literature on evidence-based stratification and treatment for intermediate-risk prostate cancer.
  • To synthesize findings on the efficacy and applicability of various treatment modalities.

Main Methods:

  • Systematic literature search of Medline and EMBASE databases up to September 2019.
  • Inclusion of hand-searched relevant studies to supplement database findings.

Main Results:

  • Multiple treatment options offer good long-term oncological outcomes for intermediate-risk prostate cancer.
  • Radical prostatectomy and dose-escalated radiotherapy with short-term androgen deprivation have robust long-term evidence.
  • Active surveillance, brachy-monotherapy, and partial gland ablation are viable options for specific patient subgroups.

Conclusions:

  • Optimal stratification and treatment for intermediate-risk prostate cancer remain subjects of ongoing debate.
  • Current classification systems aid in subgrouping but retain significant variability.
  • Advanced imaging holds promise for enhancing future stratification accuracy.