Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers

Research output: Contribution to journalArticle

Abstract

Purpose: Low-risk prostate cancer is found in about half of newly diagnosed men subjected to PSA screening. Methods: To define the role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers, an invited international panel of practicing physicians in the field of localized prostate cancer discussed the available literature in three consecutive meetings to come to a broad interpretation of the available data. Results: The panel (“new prostate cancer management group,” npm) agreed on the following observations. In most men with a low-volume Gleason 6 tumor, initial conservative management is appropriate. In men with a larger unifocal Gleason score 6 or 3 + 4 lesion, focal therapy, although still considered an investigational approach, appears to be a suitable option in early non-randomized comparison studies. Furthermore, in patients with multifocal small satellite Gleason 6 lesions in the presence of a larger index lesion, focal therapy of the index lesion is an option. For patients with high-grade, large-volume disease, or in young men with evidence of high-volume multifocal low-grade prostate cancer, whole-gland treatment should be considered. Conclusion: Active surveillance is a preferred and safe option for low-risk prostate cancer. Focal therapy is still under investigation, but the available phase II data are promising. Clinical benefits must be shown in prospective trials. With improved imaging, focal therapy may be an option for patients not choosing active surveillance with low-risk disease, progression upon active surveillance or intermediate-risk cancers with a localizable lesion.

Details

Authors
  • Henk van der Poel
  • Laurence Klotz
  • Gerald Andriole
  • Abdel Rahmène Azzouzi
  • Anders Bjartell
  • Olivier Cussenot
  • Freddy Hamdy
  • Markus Graefen
  • Paolo Palma
  • Arturo Rodriguez Rivera
  • Christian G. Stief
Organisations
External organisations
  • Netherlands Cancer Institute
  • University of Toronto
  • Washington University in St. Louis
  • CHU Angers
  • Sahlgrenska Academy
  • Institut Universitaire de France
  • University of Oxford
  • University Medical Center Hamburg-Eppendorf
  • University of Campinas
  • Hospital General Tlahuac
  • German Center for Lung Research (DZL)
Research areas and keywords

Keywords

  • Active surveillance, Consensus, Focal therapy, Intermediate risk, Low risk, Prostate cancer
Original languageEnglish
Pages (from-to)907-916
JournalWorld Journal of Urology
Volume33
Issue number7
Publication statusPublished - 2015 Jul 29
Publication categoryResearch
Peer-reviewedYes