Active surveillance (AS) for prostate cancer encompasses continued monitoring of men with very low, low, and some favorable intermediate-risk prostate cancers after the initial diagnosis. Surveillance generally includes continued PSA monitoring at set intervals, confirmatory prostate biopsy, and repeat prostate biopsies at predetermined time points (generally at least 12-24 months apart), with the goal of delaying potential curative intervention, if needed, without missing the window for a cure. No single AS strategy is currently recommended, and the time to discontinue AS has not been established; however, AS is recommended by numerous international organizations.
Radiotherapy also offers the potential for curative treatment of localized prostate cancer but, along with surgery, is considered definitive local therapy, with both short- and long-term adverse effects. Radiation may be delivered in the form of ERBT or brachytherapy. ERBT techniques include three-dimensional conformal radiation therapy and intensity-modulated radiation therapy with hypofractionation.
In general, surgical therapy for prostate cancer involves the removal of the prostate, seminal vesicles, and the draining pelvic lymph nodes (when risk indicates removal) with re-anatomosis of the bladder to the urethra. Radical retropubic prostatectomy (RRP) became the gold standard for prostate cancer surgery, according to Tosoian et al. However, most recently, robotic prostatectomy (RP) has become an established modality and has consistently demonstrated oncologic safety equivalent to that of RRP, with decreased blood loss favoring RP. Refinement of RP with techniques for sparing the periprostatic nerves, bladder neck, and space of retzius, as well as continued evaluation and understanding of anatomy, has led to improved outcomes with respect to erectile function, continence, and surgical margin positivity.
Hormone therapy for prostate cancer is also known as "androgen deprivation therapy" and is reserved for advanced metastatic disease.
Learn more about the treatment of prostate cancer.
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Cite this: Bradley Schwartz. Fast Five Quiz: Check Your Knowledge of Prostate Cancer - Medscape - Apr 18, 2022.