Risk stratification and avoiding overtreatment in localized prostate cancer
- 1 November 2019
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Urology
- Vol. 29 (6), 612-619
- https://doi.org/10.1097/mou.0000000000000672
Abstract
Significant morbidity is associated with overtreatment of clinically localized prostate cancer (PCa). Risk stratification tools such as novel biomarkers, MRI and risk calculators are useful in predicting which patients would benefit from active surveillance. This review examines current risk stratification tools in localized PCa and the safety of active surveillance in these patients. Very low risk, low-risk and favourable intermediate-risk PCa variants may benefit from treatment with active surveillance. These disease categories have been shown (with up to 10-year follow-up) to have survival and cancer-specific complication rates similar to immediate definitive treatment. Novel biomarkers sensitively predict upstaging, recurrence and metastatic progression while multiparametric MRI reliably detects clinically significant PCa and is valuable in the biopsy naïve patient considering active surveillance. Lastly, risk calculators and nomograms are being developed to combine clinical data and provide optimal individualized treatment while minimizing overtreatment in clinically localized disease. Although large randomized trials are needed to validate treatment pathways, current data supports active surveillance in certain clinically localized PCa. Many tools exist to define and support active surveillance in this group.Keywords
This publication has 62 references indexed in Scilit:
- Prognostic Utility of the Cell Cycle Progression Score Generated from Biopsy in Men Treated with ProstatectomyJournal of Urology, 2014
- A New Risk Classification System for Therapeutic Decision Making with Intermediate-risk Prostate Cancer Patients Undergoing Dose-escalated External-beam Radiation TherapyEuropean Urology, 2013
- Pathological Outcomes in Men with Low Risk and Very Low Risk Prostate Cancer: Implications on the Practice of Active SurveillanceJournal of Urology, 2013
- Prognostic Gleason grade grouping: data based on the modified Gleason scoring systemBJU International, 2013
- Radical Prostatectomy versus Observation for Localized Prostate CancerNew England Journal of Medicine, 2012
- Pathologic Findings in Radical Prostatectomy Specimens From Patients Eligible for Active Surveillance With Highly Selective Criteria: A Multicenter StudyUrology, 2012
- The quantitative Gleason score improves prostate cancer risk assessmentCancer, 2012
- Risk Profiles and Treatment Patterns Among Men Diagnosed as Having Prostate Cancer and a Prostate-Specific Antigen Level Below 4.0 ng/mLJAMA Internal Medicine, 2010
- Time Trends and Local Variation in Primary Treatment of Localized Prostate CancerJournal of Clinical Oncology, 2010
- Prostate Cancer Specific Mortality and Gleason 7 Disease Differences in Prostate Cancer Outcomes Between Cases With Gleason 4 + 3 and Gleason 3 + 4 Tumors in a Population Based CohortJournal of Urology, 2009