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Management of Localized and Locally Advanced Prostate Cancer

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A Guide to Management of Urological Cancers
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Abstract

Prostate cancer is the most common non-cutaneous malignancy, and the majority of the cancers are either localized or locally advanced at the time of diagnosis. A number of factors such as the age at diagnosis, life expectancy, comorbidities, and the aggressiveness of the cancer play an important role in deciding the final outcomes of the patient. Besides, a myriad of treatment options have been described ranging from radiotherapy to radical prostatectomy, focal ablation, and hormone therapy. In the absence of a definite evidence of survival benefit with any of the described therapeutic options, individualization of the therapeutic approach, with an aim of achieving the longest cancer-specific survival with lowest treatment-related adverse events is recommended. This review aims to discuss the various treatment options available to the patients with localized and locally advanced prostate cancer, the possible benefits and harms of each, and how to choose one over the other.

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References

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  2. Siegel DA, O’Neil ME, Richards TB, Dowling NF, Weir HK. Prostate cancer incidence and survival by stage and race/ethnicity—United States, 2001–2017. MMWR Morb Mortal Wkly Rep. 2020;69:1473–80.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Adolfsson J, Tribukait B, Levitt S. The 20-year outcome in patients with well- or moderately differentiated clinically localized prostate cancer diagnosed in the pre-PSA era: the prognostic value of tumour ploidy and comorbidity. Eur Urol. 2007;52:1028–35.

    Article  PubMed  Google Scholar 

  4. Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, et al. Outcomes of localized prostate cancer following conservative management. JAMA. 2009;302:1202–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Albertsen PC, Moore DF, Shih Wm Lin Y, Hui L, Lu-Yao GL. Impact of comorbidity on survival among men with localized prostate cancer. J Clin Oncol. 2011;29:1335–41.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wilt TJ, No TN, Langsetmo L, Dham P, Wheeler T, Aronson WL, et al. Radical prostatectomy or observation for clinically localized prostate cancer: extended follow-up of the prostate cancer intervention versus observation trial (PIVOT). Eur Urol. 2020;77:713–24.

    Article  CAS  PubMed  Google Scholar 

  7. Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med. 2016;375:1415–24.

    Article  PubMed  Google Scholar 

  8. Tosoian JJ, Mamawala M, Epstien JI, Landis P, Macura KJ, Simopoulos DN, et al. Active surveillance of grade group 1 prostate cancer: long-term outcomes from a large prospective cohort. Eur Urol. 2020;77:675–82.

    Article  PubMed  Google Scholar 

  9. Tosoian JJ, Mamawala M, Epstien JI, Landis P, Wolf S, Trock BJ, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol. 2015;33:3379–85.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schoots IG, Nieboer D, Giganti F, Moore MC, Bangma CH, Roobol M. Is magnetic resonance imaging-targeted biopsy a useful addition to systematic confirmatory biopsy in men on active surveillance for low-risk prostate cancer? A systematic review and meta-analysis. BJU Int. 2018;122:946–58.

    Article  PubMed  Google Scholar 

  11. Klotz L, Pond G, Loblaw A, Sugar L, Moussa M, Berman D, et al. Randomized study of systematic biopsy versus magnetic resonance imaging and targeted and systematic biopsy in men on active surveillance (ASIST): 2-year postbiopsy follow-up. Eur Urol. 2020;77:311–7.

    Article  PubMed  Google Scholar 

  12. Schoots IG, Moore MC, Rouviere O. Role of MRI in low-risk prostate cancer: finding the wolf in sheep’s clothing or the sheep in wolf’s clothing? Curr Opin Urol. 2017;27:238–45.

    Article  PubMed  Google Scholar 

  13. Osses DF, Drost FJH, Verbeek JFM, Luiting HB, Leenders GJLH, Bangma CH, et al. Prostate cancer upgrading with serial prostate magnetic resonance imaging and repeat biopsy in men on active surveillance: are confirmatory biopsies still necessary? BJU Int. 2020;126:124–32.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chesnut GT, Vertosick EA, Benfante N, Sjoberg DD, Fainberg J, Lee T, et al. Role of changes in magnetic resonance imaging or clinical stage in evaluation of disease progression for men with prostate cancer on active surveillance. Eur Urol. 2020;77:501–7.

    Article  PubMed  Google Scholar 

  15. Lam TBL, MacLennan S, Willemse PPM, Mason MD, Plass K, Sheperd R, Baanders R, et al. EAU-EANM-ESTRO-ESUR-SIOG prostate cancer guideline panel consensus statements for deferred treatment with curative intent for localised prostate cancer from an international collaborative study (DETECTIVE study). Eur Urol. 2019;76:790–813.

    Article  PubMed  Google Scholar 

  16. Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev. 2017;9:CD009625.

    PubMed  Google Scholar 

  17. Rosenberg JE, Jung JH, Edgerton Z, Lee H, Lee S, Bakker CJ, et al. Retzius-sparing versus standard robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer. Cochrane Database Syst Rev. 2020;8:CD013641.

    PubMed  Google Scholar 

  18. Cimino S, Reale G, Castelli T, Favilla V, Giardina R, Russo GI, et al. Comparison between Briganti, Partin and MSKCC tools in predicting positive lymph nodes in prostate cancer: a systematic review and meta-analysis. Scand J Urol. 2017;51:345–50.

    Article  PubMed  Google Scholar 

  19. Fossati N, Willemse PPM, Van den Broeck T, van den Bergh RCN, Yuan CY, Briers E, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol. 2017;72:84–109.

    Article  PubMed  Google Scholar 

  20. Carlsson S, Jaderling F, Wallerstedt A, Nyberg T, Stranne J, Thorsteinsdottir T, et al. Oncological and functional outcomes 1 year after radical prostatectomy for very-low-risk prostate cancer: results from the prospective LAPPRO trial. BJU Int. 2016;118:205–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Affenberg GB, Linsell S, Dhir A, Myers SN, Rosenberg B, Miller DC, et al. Comparison of pathological outcomes for men with low risk prostate cancer from diverse practice settings: similar results from immediate prostatectomy or initial surveillance with delayed prostatectomy. J Urol. 2016;196:1415–21.

    Article  Google Scholar 

  22. Yu T, Zhang Q, Zheng T, Shi H, Liu Y, Feng S, et al. The effectiveness of intensity modulated radiation therapy versus three-dimensional radiation therapy in prostate cancer: a meta-analysis of the literatures. PLoS One. 2016;11:e0154499.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hickey BE, Lames ML, Daly T, Soh FY, Jeffery M. Hypofractionation for clinically localized prostate cancer. Cochrane Database Syst Rev. 2019;9:CD011462.

    PubMed  Google Scholar 

  24. Widmark A, Gunnlaugsson A, Beckman L, Thellenberg-karlsson C, Hoyer M, Lagerlund M, et al. Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. Lancet. 2019;394:385–95.

    Article  PubMed  Google Scholar 

  25. Alicikus ZA, Yamada Y, Zhang Z, Pei X, Hunt M, Kollmeier M, et al. Ten-year outcomes of high dose, intensity modulated radiotherapy for localised prostate cancer. Cancer. 2011;117:1429–37.

    Article  PubMed  Google Scholar 

  26. Potters L, Morgenstern C, Calugaru E, Fearn P, Jassal A, Presser J, et al. 12-year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urol. 2005;173:1562–6.

    Article  PubMed  Google Scholar 

  27. Zamboglou N, Tselis N, Baltas D, Buhleier T, Martin T, Milickovic N, et al. High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results. Int J Radiat Oncol Biol Phys. 2013;85:672–8.

    Article  PubMed  Google Scholar 

  28. Musunuru HB, Yamamoto T, Koltz L, Ghanem G, Mamedov A, Sethukavalan P, et al. Active surveillance for intermediate risk prostate cancer: survival outcomes in the Sunnybrook experience. J Urol. 2016;196:1651–8.

    Article  PubMed  Google Scholar 

  29. Sebastian NT, McElroy JP, Martin DD, Sundi D, Diaz DA. Survival after radiotherapy vs. radical prostatectomy for unfavorable intermediate-risk prostate cancer. Urol Oncol. 2019;37:813e11–9.

    Article  Google Scholar 

  30. Studer UE, Collette L, Whelan P, Albrecht W, Casselman J, de Reijke T, et al. Using PSA to guide timing of androgen deprivation in patients with T0-4 N0-2 M0 prostate cancer not suitable for local curative treatment (EORTC 30891). Eur Urol. 2008;53:941–9.

    Article  PubMed  Google Scholar 

  31. Meissner VH, Woll M, Ankerst DP, Schiele S, Gschwend JE, Herkommer K. Long term and pathological outcomes of low and intermediate risk prostate cancer after radical prostatectomy: implications for active surveillance. World J Urol. 2021;39:3763–70.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Goy BW, Burchette R, Soper MS, Chang T, Cosmatos HA. Ten-year treatment outcomes of radical prostatectomy vs. external beam radiation therapy vs. brachytherapy for 1503 patients with intermediate-risk prostate cancer. Urology. 2020;136:180–9.

    Article  PubMed  Google Scholar 

  33. Donohue JF, Bicano FJ Jr, Kuroiwa K, Vickers AJ, Wheeler TM, Scardino PT, et al. Poorly differentiated prostate cancer treated with radical prostatectomy: long-term outcome and incidence of pathological downgrading. J Urol. 2006;176:991–5.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wk L, Bergstralh EJ, Blute ML, Slezak JM, Zincke H. Radical prostatectomy for pathological Gleason 8 or greater prostate cancer: influence of concomitant pathological variables. J Urol. 2002;167:117–22.

    Article  Google Scholar 

  35. Zelefsky MJ, Eastham JA, Cronin AM, Fuks Z, Zhang Z, Yamada Y, et al. Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol. 2010;28:1508–13.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol. 2011;59:88–95.

    Article  PubMed  Google Scholar 

  37. Chun SK, Kim JH, Ku JH, Kwak C, Lee ES, Kim S. Comparison of radical prostatectomy and external beam radiotherapy in high-risk prostate cancer. Radiat Oncol J. 2021;39:231–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Van Poppel H. Surgery for clinical T3 prostate cancer. Eur Urol Suppl. 2005;4:12–4.

    Article  Google Scholar 

  39. Van Poppel H, Goethuys H, Callewaert P, Vanuytsel L, Van de Voorde W, Baert L. Radical prostatectomy can provide a cure for well-selected clinical stage T3 prostate cancer. Eur Urol. 2000;38:372–9.

    Article  PubMed  Google Scholar 

  40. van den Ouden D, Hop WC, Schroder FH. Progression in and survival of patients with locally advanced prostate cancer (T3) treated with radical prostatectomy as monotherapy. J Urol. 1998;160:1392–7.

    Article  PubMed  Google Scholar 

  41. Zhou X, Jin K, Qui S, Jin D, Liao X, Zheng X, et al. Comparing effectiveness of radical prostatectomy versus external beam radiotherapy in patients with locally advanced prostate cancer: a population based analysis. Medicine. 2020;99:e21642.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Parker CC, Clarke NW, Cook AD, Kynaston HG, Petersen PM, Catton C, et al. Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial. Lancet. 2020;396:1413–21.

    Article  CAS  PubMed  Google Scholar 

  43. Pommier P, Chabaud S, Lagrange JL, Richaud P, Lesaunier F, Prise EL, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol. 2007;25:5366–73.

    Article  PubMed  Google Scholar 

  44. Cohen JK, Miller RJ Jr, Ahmed S, Lotz MJ, Baust J. Ten-year biochemical disease control for patients with prostate cancer treated with cryosurgery as primary therapy. Urology. 2008;71:515–8.

    Article  PubMed  Google Scholar 

  45. Guo X, Liu S, Wang M, Hou H, Wang X, Zhang Z, et al. Comparing the oncological outcomes of Cryoablation vs. radical prostatectomy in low-intermediate risk localized prostate cancer. Front Oncol. 2020;10:1489.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ramsay CR, Adewuyi TE, Gray J, Hislop J, Shirley MDF, Jayakody S, et al. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. Health Technol Assess. 2015;19:1–490.

    Article  PubMed  PubMed Central  Google Scholar 

  47. He Y, Tan P, He M, Hu L, Ai J, et al. The primary treatment of prostate cancer with high frequency focussed ultrasound: a systematic review and meta-analysis. Medicine. 2020;99:e22601.

    Article  Google Scholar 

  48. Gelet A, Crouzet S, Rouviere O, Chapelon JY, Rabilloud M. Radical prostatectomy versus high intensity focused ultrasound for localized prostate cancer: a matched pair comparison. J Ther Ultrasound. 2015;3:O56.

    Article  PubMed Central  Google Scholar 

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Yadav, S., Kumar, A. (2023). Management of Localized and Locally Advanced Prostate Cancer. In: Singh, P., Nayak, B., Panaiyadiyan, S. (eds) A Guide to Management of Urological Cancers. Springer, Singapore. https://doi.org/10.1007/978-981-99-2341-0_16

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  • DOI: https://doi.org/10.1007/978-981-99-2341-0_16

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