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

van der Poel, Henk; Klotz, Laurence; Andriole, Gerald; Azzouzi, Abdel Rahmène; Bjartell, Anders LU ; Cussenot, Olivier; Hamdy, Freddy; Graefen, Markus; Palma, Paolo and Rivera, Arturo Rodriguez, et al. (2015) In World Journal of Urology 33(7). p.907-916
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... (More)

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.

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publishing date
type
Contribution to journal
publication status
published
keywords
Active surveillance, Consensus, Focal therapy, Intermediate risk, Low risk, Prostate cancer
in
World Journal of Urology
volume
33
issue
7
pages
907 - 916
publisher
Springer
external identifiers
  • scopus:84933179128
ISSN
0724-4983
DOI
10.1007/s00345-015-1603-7
language
English
LU publication?
no
id
79b3da4b-d55d-470d-a953-fd12861448e5
date added to LUP
2019-06-28 10:28:59
date last changed
2019-07-30 05:05:17
@article{79b3da4b-d55d-470d-a953-fd12861448e5,
  abstract     = {<p>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.</p>},
  author       = {van der Poel, Henk and Klotz, Laurence and Andriole, Gerald and Azzouzi, Abdel Rahmène and Bjartell, Anders and Cussenot, Olivier and Hamdy, Freddy and Graefen, Markus and Palma, Paolo and Rivera, Arturo Rodriguez and Stief, Christian G.},
  issn         = {0724-4983},
  keyword      = {Active surveillance,Consensus,Focal therapy,Intermediate risk,Low risk,Prostate cancer},
  language     = {eng},
  month        = {07},
  number       = {7},
  pages        = {907--916},
  publisher    = {Springer},
  series       = {World Journal of Urology},
  title        = {Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers},
  url          = {http://dx.doi.org/10.1007/s00345-015-1603-7},
  volume       = {33},
  year         = {2015},
}