Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy .
A biopsy progression indicates the need for active intervention , whereas the role of PSA doubling time is controversial .
In men with locally advanced PCa for 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 recommended mostly for patients with localized disease and a long life expectancy , with radical prostatectomy ( RP ) shown to be superior to WW in prospect i ve r and omized trials .
Nerve-sparing RP is the approach of choice in organ-confined disease , while neoadjuvant ADT provides no improvement in outcome variables .
For locally advanced disease , adjuvant ADT for 3 yr results in superior rates for disease-specific and overall survival and is the treatment of choice .
Active surveillance is an option in low-risk PCa and watchful waiting is an alternative to and rogen-deprivation therapy in locally advanced PCa not requiring immediate local treatment .
CONTEXT The most recent summary of the European Association of Urology ( EAU ) guidelines on prostate cancer ( PCa ) was published in 2011 .
OBJECTIVE To present a summary of the 2013 version of the EAU guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly organ-confined PCa .
Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa .
Systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic method .
CONCLUSIONS Knowledge in the field of PCa is rapidly changing .
Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the Radiation Therapy Oncology Group Protocol 92-02.
PURPOSE Radiation Therapy Oncology Group ( RTOG ) Protocol 92 - 02 was a r and omized trial testing long-term ( LT ) adjuvant and rogen deprivation ( AD ) after initial AD with external-beam radiotherapy ( RT ) in patients with locally advanced prostate cancer ( PC ; T2c-4 ) and with prostate-specific antigen level less than 150 ng/mL. PATIENTS AND METHODS Patients received a total of 4 months of goserelin and flutamide , 2 months before and 2 months during RT . A radiation dose of 65 to 70 Gy was given to the prostate and a dose of 44 to 50 Gy to the pelvic lymph nodes . Patients were r and omly assigned to receive no additional therapy ( short-term [ST]AD-RT ) or 24 months of goserelin ( LTAD-RT ) ; 1,554 patients were entered onto the study . RESULTS The LTAD-RT arm showed significant improvement in all efficacy end points except overall survival ( OS ; 80.0 % v 78.5 % at 5 years , P = .73 ) , compared with the STAD-RT arm . In a subset of patients not part of the original study design , with tumors assigned Gleason scores of 8 to 10 by the contributing institutions , the LTAD-RT arm had significantly better OS ( 81.0 % v 70.7 % , P = .044 ) . There was a small but significant increase in the frequency of late radiation grade s 3 , 4 , and 5 gastrointestinal toxicity ascribed to the LTAD-RT arm ( 2.6 % v 1.2 % at 5 years , P = .037 ) , the cause of which is not clear . CONCLUSION The RTOG 92 - 02 trial supports the addition of LT adjuvant AD to STAD with RT for T2c-4 PC . In the exploratory subset analysis of patients with Gleason scores 8 to 10 , LT adjuvant AD result ed in a survival advantage
Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy .
A biopsy progression indicates the need for active intervention , whereas the role of PSA doubling time is controversial .
In men with locally advanced PCa for 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 recommended mostly for patients with localized disease and a long life expectancy , with radical prostatectomy ( RP ) shown to be superior to WW in prospect i ve r and omized trials .
Nerve-sparing RP is the approach of choice in organ-confined disease , while neoadjuvant ADT provides no improvement in outcome variables .
For locally advanced disease , adjuvant ADT for 3 yr results in superior rates for disease-specific and overall survival and is the treatment of choice .
Active surveillance is an option in low-risk PCa and watchful waiting is an alternative to and rogen-deprivation therapy in locally advanced PCa not requiring immediate local treatment .
CONTEXT The most recent summary of the European Association of Urology ( EAU ) guidelines on prostate cancer ( PCa ) was published in 2011 .
OBJECTIVE To present a summary of the 2013 version of the EAU guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly organ-confined PCa .
Current evidence is insufficient to warrant widespread population -based screening by prostate-specific antigen ( PSA ) for PCa .
Systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic method .
CONCLUSIONS Knowledge in the field of PCa is rapidly changing .