Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy .
PSA doubling time in <3 yr or a biopsy progression indicates the need for active intervention .
In men with locally advanced PCa in whom local therapy is not m and atory , watchful waiting ( WW ) is a treatment alternative to and rogen-deprivation therapy ( ADT ) with equivalent oncologic efficacy .
Active treatment is mostly recommended for patients with localised disease and a long life expectancy with radical prostatectomy ( RP ) shown to be superior to WW in a prospect i ve r and omised trial .
Nerve-sparing RP represents the approach of choice in organ-confined disease ; neoadjuvant and rogen deprivation demonstrates no improvement of outcome variables .
For locally advanced disease , adjuvant ADT for 3 yr results in superior disease-specific and overall survival rates and represents the treatment of choice .
OBJECTIVE Our aim was to present a summary of the 2010 version of the European Association of Urology ( EAU ) guidelines on the screening , diagnosis , and treatment of clinical ly localised cancer of the prostate ( PCa ) .
Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa .
A systematic prostate biopsy under ultrasound guidance and local anaesthesia is the preferred diagnostic method .
Patient-reported long-term outcomes after conventional and high-dose combined proton and photon radiation for early prostate cancer.
CONTEXT Increased radiation doses improve prostate cancer control but also increase toxicity to adjacent normal tissue . Proton radiation may attenuate adverse effects . OBJECTIVE To determine long-term , patient-reported , dose-related toxicity . DESIGN , SETTING , AND PATIENTS We performed a post hoc cross-sectional survey of surviving participants in the Proton Radiation Oncology Group ( PROG ) 9509 - -a r and omized trial comparing 70.2 Gy vs 79.2 Gy of combined photon and proton radiation for 393 men with clinical ly localized prostate cancer ( stage T1b-T2b , prostate-specific antigen < 15 ng/mL , and no radiographic evidence of metastasis ) . The estimated 10-year biochemical progression rate for patients receiving st and ard dose was 32 % ( 95 % confidence interval , 26%-39 % ) compared with 17 % ( 95 % confidence interval , 11%-23 % ) for patients receiving high dose ( P < .001 ) . We surveyed 280 of the surviving 337 patients ( 83 % ) from April 2007 to September 2008 . MAIN OUTCOME MEASURES Prostate Cancer Symptom Indices , a vali date d measure of urinary incontinence , urinary obstruction and irritation , bowel problems , and sexual dysfunction , and related quality -of-life instruments . RESULTS At a median of 9.4 years after treatment ( range , 7.4 - 12.1 years ) , participants ' demographic and clinical characteristics were similar . Patient-reported outcomes were reported as mean ( SD ) scale score for st and ard dose vs high dose : urinary obstruction/irritation ( 23.3 [ 13.7 ] vs 24.6 [ 14.0 ] ; P = .36 ) , urinary incontinence ( 10.6 [ 17.7 ] vs 9.7 [ 15.8 ] ; P = .99 ) , bowel problems ( 7.7 [ 7.8 ] vs 7.9 [ 9.1 ] ; P = .70 ) , sexual dysfunction ( 68.2 [ 34.6 ] vs 65.9 [ 34.7 ] ; P = .65 ) , and most other outcomes were also similar , although patients receiving st and ard dose whose cancers had more often progressed expressed less confidence that their cancers were under control ( mean [ SD ] scale score for st and ard dose , 76.0 [ 25.4 ] vs high dose , 86.2 [ 17.9 ] ; P < .001 ) . Many patients characterized their urinary and bowel function as normal despite reporting symptoms that , for other prostate cancer patients before and early after cancer treatment , caused substantial distress . CONCLUSION Among men with clinical ly localized prostate cancer , treatment with higher-dose radiation compared with st and ard dose was not associated with an increase in patient-reported prostate cancer symptoms after a median of 9.4 years
Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy .
PSA doubling time in <3 yr or a biopsy progression indicates the need for active intervention .
In men with locally advanced PCa in whom local therapy is not m and atory , watchful waiting ( WW ) is a treatment alternative to and rogen-deprivation therapy ( ADT ) with equivalent oncologic efficacy .
Active treatment is mostly recommended for patients with localised disease and a long life expectancy with radical prostatectomy ( RP ) shown to be superior to WW in a prospect i ve r and omised trial .
Nerve-sparing RP represents the approach of choice in organ-confined disease ; neoadjuvant and rogen deprivation demonstrates no improvement of outcome variables .
For locally advanced disease , adjuvant ADT for 3 yr results in superior disease-specific and overall survival rates and represents the treatment of choice .
OBJECTIVE Our aim was to present a summary of the 2010 version of the European Association of Urology ( EAU ) guidelines on the screening , diagnosis , and treatment of clinical ly localised cancer of the prostate ( PCa ) .
Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa .
A systematic prostate biopsy under ultrasound guidance and local anaesthesia is the preferred diagnostic method .