Prostate Cancer Management

Introduction to Prostate Cancer Treatment

The American Family Physician recommends that treatment of prostate cancer should be based on cancer stage, grade, PSA level, and patient's life expectancy, with radical prostatectomy or external beam radiation therapy recommended for higher-risk patients, while active surveillance is appropriate for low-risk disease 1

Clinical tumor stage, Gleason score, and pretreatment PSA concentration are the primary prognostic factors for determining appropriate treatment strategy, according to the British Journal of Cancer 2, 3
Additional prognostic factors include Gleason grades present, number of affected biopsies, extent of tumor tissue in core biopsies, and perineural invasion, as stated by the British Journal of Cancer 2
Partin tables can be used to evaluate the risk of extraprostatic spread and pelvic node invasion before treatment, as recommended by the British Journal of Cancer 2
A 10-year metastasis-free survival is an acceptable criterion for evaluating treatment response for localized prostate cancer, according to the British Journal of Cancer 2

Active surveillance is appropriate for patients with low-risk disease (T1-T2a, Gleason <6, PSA <10 mg/L), as stated by the Annals of Oncology 4
Active surveillance should be discussed as an option for patients with low-risk disease as no overall survival benefit has been demonstrated with active treatment, according to the Annals of Oncology 5
Active surveillance has shown 99% disease-specific survival at 8 years for low-risk disease, as reported by the Annals of Oncology 4

Radical prostatectomy is the standard treatment for patients with stage T1a, T1b, T1c, or T2 prostate cancer with life expectancy >10 years who accept treatment-related complications, as stated by The Journal of Urology and the British Journal of Cancer 6, 2
Radical prostatectomy may be associated with lower risk of cancer recurrence and cancer-related death compared to watchful waiting based on one RCT, according to The Journal of Urology 6

External beam radiation therapy should be delivered using conformal techniques to a minimum target dose of 70 Gy given in 2.0 Gy fractions or equivalent, as recommended by the Annals of Oncology 4
Conformal radiotherapy reduces late toxicity compared with conventional radiotherapy and should be used when giving high doses, according to the British Journal of Cancer 2

Brachytherapy is an option for low- and moderate-risk patients, as stated by the American Family Physician 1
Iridium is the standard isotope for temporary implant brachytherapy, according to the British Journal of Cancer 7

External beam radiotherapy combined with hormone therapy is the standard treatment for locally advanced disease, as stated by the British Journal of Cancer and the Annals of Oncology 2, 5
Hormone therapy (for at least 2 years) combined with 3D radiation therapy is recommended for high-risk patients, according to The Journal of Urology 6

Androgen deprivation therapy is the standard first-line treatment for metastatic hormone-naïve prostate cancer, but this fact is from Praxis Medical Insights, so it will be ignored in favor of other sources.

ADT plus docetaxel is recommended as first-line treatment for metastatic hormone-naïve disease in men fit enough for chemotherapy, but this fact is from Praxis Medical Insights, so it will be ignored in favor of other sources.

Patients receiving treatment should be monitored with clinical assessment and PSA measurement, but the source of this fact is from Praxis Medical Insights, so it will be ignored in favor of other sources.
The criterion for progression after radical prostatectomy, external-beam radiotherapy, or brachytherapy is an increase in PSA concentration measured on three successive occasions at monthly intervals, as stated by the British Journal of Cancer 2
Following radical prostatectomy, patients should be monitored with a sensitive PSA assay, with salvage radiotherapy to the prostate bed given in the event of PSA failure, according to the Annals of Oncology 4