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Initial approach to low- and very low-risk clinically localized prostate cancer

Eric A Klein, MD
Jay P Ciezki, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


Most prostate cancers now are diagnosed while clinically localized, based in part upon the widespread use of serum prostate specific antigen (PSA) measurement. Treatment planning needs to incorporate the natural history of the disease and the risk of progression, since many of these cancers are biologically indolent and may never threaten the health or life of the patient.

For patients diagnosed with prostate cancer confined to the prostate, standard management options include radical prostatectomy, radiation therapy (external beam, brachytherapy), and, for carefully selected patients with very low or low-risk disease, active surveillance.

Key factors in choosing treatment for a man with low-risk prostate cancer include the likelihood of recurrence or metastasis following treatment (risk stratification), the patient's age and life expectancy, the presence or absence of significant comorbidity, and patient preferences. (See "Prostate cancer: Risk stratification and choice of initial treatment", section on 'Risk stratification'.)

This topic discusses the initial management approach for men with low-risk prostate cancer. The approach to treatment of men with intermediate and high-risk prostate cancer, locally advanced (very high risk) disease, and stage IV disease (clinical lymph node involvement or disseminated metastases) are discussed separately:

(See "Initial management of regionally localized intermediate-, high-, and very high-risk prostate cancer".)

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Literature review current through: Nov 2017. | This topic last updated: Mar 29, 2017.
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