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Prostate Cancer Treatment Options
- Prostate cancer: Epidemiology and etiology
- Prostate cancer: Pathology
- Prostate cancer: Signs and symptoms
- Prostate cancer: Screening
- Prostate cancer: Staging
- Prostate cancer: Treatment options
- Prostate cancer: Active surveillance
- Prostate cancer: Prostatectomy
- Prostate cancer: Radiation therapy
- Prostate cancer: Brachytherapy
- Prostate cancer: TURP and experimental treatment options
- Prostate cancer: androgen deprivation therapy of advanced prostate cancer
- Prostate cancer: Treatment of castration-resistant prostate cancer
Guidelines and review literature: (EAU Guidelines Prostate Cancer) (S3-Leitlinie Prostatakarzinom) (Walsh-Campbell Urology).
Treatment Options for Prostate Cancer According to Clinical Risk and Life Expectancy
For clinical risk stratification, see the D’Amico risk stratification of prostate cancer.
Localized Prostate Cancer
Low Clinical Risk:
Prostate cancer-specific mortality is low over 20 years. Randomized trials found no significant difference between observation and radical prostatectomy after 10 years (Wilt et al., 2012) (Hamdy et al., 2016). After 20 years, the PIVOT trial showed a 5 % survival benefit for patients undergoing radical prostatectomy versus observation; surgery also reduced the need for androgen deprivation therapy (22 % versus 44 %) (Wilt et al., 2017).
Life Expectancy Over 15 Years:
Active surveillance is the preferred treatment option. If the disease progresses to a less favorable risk profile or at the patient’s request, radical prostatectomy or curative radiation therapy are appropriate.
Life Expectancy Below 15 Years:
Active surveillance is the treatment of choice. If the disease progresses, curative radiation therapy or surgery is appropriate. Watchful waiting is appropriate in patients with limited life expectancy, substantial comorbidity, or a preference for it; start androgen deprivation therapy only for symptomatic progression or metastases.
Intermediate and High Clinical Risk:
There is a relevant risk of progression to metastatic disease within 10 years or death from prostate cancer within 15 years. Offer curative-intent treatment to patients with a life expectancy of at least 10 years. After detailed counseling, active surveillance may also be discussed for favorable intermediate-risk disease.
Life Expectancy Over 10 Years:
Appropriate curative options are radical prostatectomy with risk-adapted pelvic lymph node dissection or curative radiation therapy with risk-adapted androgen deprivation therapy.
Life Expectancy Below 10 Years:
Curative radiation therapy with adjuvant androgen deprivation therapy is the treatment of choice. In patients with subvesical obstruction, radical prostatectomy should be preferred.
Life Expectancy Below 5 Years:
Do not offer curative treatment; regular clinical follow-up is sufficient. Perform TURP for subvesical obstruction. Start androgen deprivation therapy for symptomatic local progression or metastases.
Metastatic Prostate Cancer
Use combination therapy with androgen deprivation therapy and a modern androgen receptor signaling inhibitor; see the treatment algorithm for advanced prostate cancer. Numerous further treatment options are available after progression. Otherwise, palliation of symptoms is paramount, including pain management, bisphosphonates, radiation therapy, and blood transfusions. In oligometastatic patients with a long life expectancy, local treatment (external beam radiation therapy or radical prostatectomy) and radiation therapy to metastases may be considered in addition to androgen deprivation therapy. In patients with de novo metastatic prostate cancer and high-volume disease, administer six cycles of docetaxel after initiating androgen deprivation therapy.
| Prostate cancer staging | Index | Prostate cancer active surveillance |
Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
References
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Deutsche Version: Leitlinien: Therapie Optionen des Prostatakarzinoms
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