Prostate cancer: Risk stratification and choice of initial treatment
- Eric A Klein, MD
Eric A Klein, MD
- Chairman, Glickman Urological and Kidney Institute
- Professor of Surgery
- Cleveland Clinic
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Prostate cancer is the second most common cancer in men worldwide, with an estimated 1,100,000 cases and 307,000 deaths in 2012 . In developed areas, prostate cancer is increasingly being diagnosed when the tumor is confined to the prostate, due at least in part, to screening with prostate specific antigen (PSA). However, prostate cancers confined to the gland may become less frequent than more invasive tumors as PSA screening rates fall .
For men with newly diagnosed prostate cancer, the most important factors in selecting the initial treatment include the following:
●Anatomic extent of disease (tumor, node, metastasis stage)
●Histologic grade (Gleason score/grade group) of the tumor
●Serum PSA level
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- RISK STRATIFICATION
- TNM staging and Gleason grade group
- Clinical versus pathologic staging
- APPROACH TO TREATMENT BASED UPON RISK STRATIFICATION
- Clinically localized, NCCN very low risk
- Clinically localized, NCCN low risk
- Clinically localized, NCCN intermediate risk
- Clinically localized, NCCN high risk
- - Biopsy Gleason score 9 or 10
- Clinically locally advanced or NCCN very high risk
- Clinical lymph node involvement
- Disseminated metastases
- OTHER PROGNOSTIC FACTORS
- Percentage of positive biopsies
- Cancer volume
- Perineural invasion
- Disseminated cancer cells
- PREDICTIVE TOOLS
- INFORMATION FOR PATIENTS