Prostate Cancer Evaluation and Initial Management
Prostate cancer management is determined by clinical stage, Grade Group (from Gleason score), PSA level, and imaging-based assessment of local extent and metastasis. (auajournals.org)
Risk-adapted strategies include active surveillance for selected low-risk disease, definitive local therapy (radical prostatectomy or radiation therapy) for most localized disease, and androgen-deprivation therapy (ADT) with treatment intensification for metastatic hormone-sensitive disease. (auajournals.org)
Screening and Diagnostic Entry Points
PSA-based screening in asymptomatic men ages 55 to 69 years should be an individual decision after shared decision-making that weighs potential benefits and harms. [1]
Prostate cancer screening is not recommended for men 70 years and older. [1]
Diagnostic Workup and Staging Principles
Localized treatment planning is based on a combination of PSA, biopsy Grade Group, and clinical T stage. (auajournals.org)
Risk-based staging commonly includes assessment for nodal and distant disease when clinical risk is sufficient to change management. (auajournals.org)
Risk Stratification Frameworks
Risk stratification integrates PSA, Grade Group, and clinical stage to guide selection among active surveillance, definitive local therapy, or systemic therapy. (auajournals.org)
Imaging and biopsy findings (including MRI-targeted approaches) are used to refine candidacy for active surveillance and to reduce risk of undertreatment. (uroweb.org)
Localized Disease Treatment Options
Active surveillance is used for selected low-risk disease in which close monitoring can detect progression early. (auajournals.org)
Definitive local therapy options include radical prostatectomy and radiation therapy. (auajournals.org)
Active surveillance does not provide curative intent and requires protocol-driven follow-up with triggers for conversion to definitive treatment. (auajournals.org)
Active Surveillance Follow-Up
PSA is typically measured frequently during active surveillance. [2]
Multiparametric MRI is commonly incorporated during follow-up to reassess disease status, including at defined intervals. [2]
Confirmatory assessment with repeat biopsy strategies may be used based on protocol and MRI/PSA concerns. (auajournals.org)
Key Evidence for Active Treatment in Early/Localized Disease
Radical prostatectomy reduced distant metastases and prostate cancer mortality compared with watchful waiting in the SPCG-4 randomized trial with long-term follow-up. [3]
Metastatic Hormone-Sensitive Prostate Cancer Treatment Intensification
ADT is the backbone of metastatic hormone-sensitive prostate cancer therapy. [4]
Adding abiraterone plus prednisone to ADT increased overall survival compared with ADT alone in STAMPEDE, with a hazard ratio for overall survival of 0.63 (95% CI 0.52–0.76). [5]
Meta-analytic synthesis of LATITUDE and STAMPEDE showed a 38% reduction in risk of death with abiraterone plus ADT versus ADT alone (HR approximately 0.62), corresponding to a 14% absolute improvement in 3-year overall survival. [6]
ADT plus docetaxel also provided a survival benefit compared with ADT alone in metastatic hormone-sensitive disease trials included in ASCO guidance summaries (hazard ratios reported in the source as 0.78 and 0.73 for STAMPEDE-associated and CHAARTED-associated analyses, respectively). [4]