Initial approach to low- and very low-risk clinically localized prostate cancer
- Eric A Klein, MD
Eric A Klein, MD
- Chairman, Glickman Urological and Kidney Institute
- Professor of Surgery
- Cleveland Clinic
- Jay P Ciezki, MD
Jay P Ciezki, MD
- Staff Physician
- Cleveland Clinic Department of Radiation Oncology
- 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
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:
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- Chen RC, Basak R, Meyer AM, et al. Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer. JAMA 2017; 317:1141.
- RISK STRATIFICATION
- TREATMENT APPROACHES
- Active surveillance
- Radiation therapy
- - External beam RT
- - Brachytherapy
- Patient selection
- Radical prostatectomy
- - Localized disease
- - Pathologic T3, margin positive disease, and microscopic lymph node involvement
- - Complications
- Urinary incontinence
- Erectile dysfunction
- Other approaches
- - Ablation therapy
- - Androgen deprivation therapy alone
- - Antiandrogen monotherapy
- Radical prostatectomy
- External beam RT
- CHOICE OF THERAPY
- ProtecT trial
- Quality of life
- POST-TREATMENT SURVEILLANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS