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 .
Competing event risk stratification may improve the design and efficiency of clinical trials: secondary analysis of SWOG 8794.
BACKGROUND Composite endpoints can be problematic in the presence of competing risks when a treatment does not affect events comprising the endpoint equally . METHODS We conducted secondary analysis of SWOG 8794 trial of adjuvant radiation therapy ( RT ) for high-risk post-operative prostate cancer . The primary outcome was metastasis-free survival ( MFS ) , defined as time to first occurrence of metastasis or death from any cause ( competing mortality ( CM ) ) . We developed separate risk scores for time to metastasis and CM using competing risks regression . We estimated treatment effects using Cox models adjusted for risk scores and identified an enriched subgroup of 75 patients at high risk of metastasis and low risk of CM . RESULTS The mean CM risk score was significantly lower in the RT arm vs. control arm ( p=0.001 ) . The effect of RT on MFS ( HR 0.70 ; 95 % CI , 0.53 - 0.92 ; p=0.010 ) was attenuated when controlling for metastasis and CM risk ( HR 0.76 ; 95 % CI , 0.58 - 1.00 ; p=0.049 ) , and the effect of RT on overall survival ( HR 0.73 ; 95 % CI , 0.55 - 0.96 ; p=0.02 ) was no longer significant when controlling for metastasis and CM risk ( HR 0.80 ; 95 % CI , 0.60 - 1.06 ; p=0.12 ) . Compared to the whole sample , the enriched subgroup had the same 10-year incidence of MFS ( 40 % ; 95 % CI , 22 - 57 % ) , but a higher incidence of metastasis ( 30 % ( 95 % CI , 15 - 47 % ) vs. 20 % ( 95 % CI , 15 - 26 % ) ) . A r and omized trial in the subgroup would have achieved 80 % power with 56 % less patients ( 313 vs. 709 , respectively ) . CONCLUSION Stratification on competing event risk may improve the efficiency of clinical trials
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 .