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Title: Risk stratification and avoiding overtreatment in localized prostate cancer.
Authors: Hanna, Bishoy;Ranasinghe, Weranja;Lawrentschuk, Nathan
Affiliation: Northern Sydney Local Health District, New South Wales..
EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
Orange Base Hospital, Orange, New South Wales..
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Cancer Surgery, Peter MacCallum Cancer Centre
Issue Date: 28-Aug-2019
EDate: 2019-08-28
Citation: Current opinion in urology 2019; online first: 28 August
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.
DOI: 10.1097/MOU.0000000000000672
ORCID: 0000-0001-8553-5618
PubMed URL: 31469662
Type: Journal Article
Appears in Collections:Journal articles

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