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 .
Combination of adjuvant hormonal and radiation therapy significantly prolongs survival of patients with pT2-4 pN+ prostate cancer: results of a matched analysis.
BACKGROUND Previous prospect i ve r and omised trials have shown a positive impact of adjuvant radiation therapy ( RT ) in patients with locally advanced prostate cancer . However , none of these trials included patients with lymph node invasion ( LNI ) . OBJECTIVE The aim of this study was to assess the impact of combination adjuvant hormonal therapy ( HT ) and RT on the survival of patients with prostate cancer and histologically documented lymph node metastases ( pN+ ) . DESIGN , SETTING , AND PARTICIPANTS Data on 703 consecutive patients with LNI treated with radical prostatectomy , pelvic lymph node dissection , and adjuvant treatments between September 1986 and November 2002 at two large academic institutions were review ed . MEASUREMENTS For study purpose s , patients treated with adjuvant HT plus RT and patients treated with adjuvant HT alone were matched for age at surgery , pathologic T stage and Gleason score , number of nodes removed , surgical margin status , and length of follow-up . Differences in cancer-specific survival ( CSS ) and overall survival ( OS ) were compared using the Kaplan-Meier method and life table analyses . RESULTS AND LIMITATIONS Following the matching process , 117 pT2 - 4 pN1 patients of 171 ( 68.4 % ) treated with adjuvant HT plus RT ( group 1 ) were compared with 247 pT2 - 4 pN1 patients of 532 ( 46.4 % ) receiving adjuvant HT alone ( group 2 ) . After matching , the two groups of patients were comparable in terms of pre- and postoperative characteristics ( all p ≥ 0.07 ) . Mean follow-up was 100.8 mo ( median : 95.1 mo ; range : 3.5 - 229.3 mo ) . Overall , prostate CSS and OS rates at 5 , 8 , and 10 yr were 90 % , 82 % , and 75 % , and 85 % , 70 % , and 60 % , respectively . Patients treated with adjuvant RT plus HT had significantly higher CSS and OS rates compared with patients treated with HT alone at 5 , 8 , and 10 yr after surgery ( 95 % , 91 % , and 86 % vs 88 % , 78 % , and 70 % , and 90 % , 84 % , and 74 % vs 82 % , 65 % , and 55 % , respectively ; p = 0.004 and p<0.001 , respectively ) . Similarly , higher survival rates associated with the combination of HT plus RT were found when patients were stratified according to the extent of nodal invasion ( namely , two or fewer vs more than two positive nodes ; all p ≤ 0.006 ) . Lack of st and ardised HT and RT protocol s represents the main limitations of our retrospective study . CONCLUSIONS Adjuvant RT plus HT significantly improved CSS and OS of pT2 - 4 pN1 patients , regardless of the extent of nodal invasion . These results reinforce the need for a multimodal approach in the treatment of node-positive prostate cancer
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 .