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 .
High-risk prostate cancer treated with pelvic radiotherapy and 36 versus 18 months of androgen blockade: Results of a phase III randomized study.
3 Background : Radiotherapy ( RT ) and long term and rogen blockade ( AB ) is st and ard treatment for patients with high risk prostate cancer . However , the optimal duration of AB is not yet defined . The purpose of this r and omized study was to compare outcomes between 36 vs. 18 months of AB in high risk prostate cancer treated with RT ( PCS IV trial , Clinical Trials.gov , # NCT00223171 ) . METHODS PCS IV r and omized patients with node negative high risk prostate cancer ( T3 - 4 , PSA > 20 ng/ml or Gleason score > 7 ) , to pelvic RT ( whole pelvis 44 Gy/4 ½ weeks , prostate 70 Gy/7 weeks ) and 36 ( arm 1 ) vs. 18 months ( arm 2 ) of AB ( neo adjuvant , concomitant , adjuvant ) . AB consisted of bicalutamide 50 mg for one month plus goserelin 10.8 mg every three months for 36 vs. 18 months . Overall survival was the primary end point . Overall and cancer specific survival rates were compared between arms with Kaplan-Meier log rank test and Cox regression . RESULTS From October 2000 to January 2008 , 310 patients were r and omized to arm 1 and 320 to arm 2 . Patients ' characteristics were well balanced between the two arms ( median age 71 years , median PSA 16 ng/ml , median Gleason score 8) . Most patients had T2 - 3 disease . At a median follow-up of 77 months , 71/310 patients ( 22.9 % ) in arm 1 and 76/320 ( 23.8 % ) in arm 2 had died ( p=0.802 ) . Overall , 116 patients died of causes other than prostate cancer . Overall and cancer specific survival hazard ratios were 1.15 ( 0.83 - 1.59 ) , p=0.398 and 1.13 ( 0.61 - 2.08 ) , p=0.153 , respectively . 5 year overall and disease specific survival rates were 92.1 % ( 89.1 - 95.1 ) vs. 86.8 % ( 83.0 - 90.6 ) , p=0.052 and 97.6 % ( 95.9 - 99.4 ) vs. 96.4 % ( 94.2 - 98.6 ) , p=0.473 and 10 year overall and disease specific survival rates were 63.6 % ( 55.7 - 71.5 ) vs. 63.2 % ( 54.7 - 71.7 ) , p=0.429 and 87.2 % ( 81.0 - 93.3 ) vs. 87.2 % ( 80.9 - 93.6 ) , p=0.838 for arm 1 and arm 2 , respectively . There were no significant differences in the rates of biochemical , regional or distant failure between arms . CONCLUSIONS Our study shows that long term AB can be safely reduced from 36 to 18 months without compromising outcomes . Analysis of treatment impact on quality of life is now under review . SOURCE OF FUNDING AstraZeneca Pharmaceuticals Grant . CLINICAL TRIAL INFORMATION Clinical Trials.gov , # NCT00223171
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 .