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Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers

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Abstract

Purpose

Low-risk prostate cancer is found in about half of newly diagnosed men subjected to PSA screening.

Methods

To define the role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers, an invited international panel of practicing physicians in the field of localized prostate cancer discussed the available literature in three consecutive meetings to come to a broad interpretation of the available data.

Results

The panel (“new prostate cancer management group,” npm) agreed on the following observations. In most men with a low-volume Gleason 6 tumor, initial conservative management is appropriate. In men with a larger unifocal Gleason score 6 or 3 + 4 lesion, focal therapy, although still considered an investigational approach, appears to be a suitable option in early non-randomized comparison studies. Furthermore, in patients with multifocal small satellite Gleason 6 lesions in the presence of a larger index lesion, focal therapy of the index lesion is an option. For patients with high-grade, large-volume disease, or in young men with evidence of high-volume multifocal low-grade prostate cancer, whole-gland treatment should be considered.

Conclusion

Active surveillance is a preferred and safe option for low-risk prostate cancer. Focal therapy is still under investigation, but the available phase II data are promising. Clinical benefits must be shown in prospective trials. With improved imaging, focal therapy may be an option for patients not choosing active surveillance with low-risk disease, progression upon active surveillance or intermediate-risk cancers with a localizable lesion.

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Acknowledgments

The consensus meetings were made possible by support of STEBA Biotech.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Henk van der Poel

  2. Division of Urology, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada

    Laurence Klotz

  3. Division of Urology, Department of Surgery, Washington University St Louis, St. Louis, MO, USA

    Gerald Andriole

  4. Service d’Urologie, CHU d’Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France

    Abdel-Rahmène Azzouzi

  5. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden

    Anders Bjartell

  6. Institute Universitaire de Cancerologie, UPMC Univ Paris 06, GRC-05, ONCOTYPE-Uro, 75005, Paris, France

    Olivier Cussenot

  7. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

    Freddy Hamdy

  8. Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Markus Graefen

  9. Universidade Estadual de Campinas, Campinas, Brazil

    Paolo Palma

  10. Department of Urology, Hospital General Tlahuac, Tláhuac, Mexico

    Arturo Rodriguez Rivera

  11. Department of Urology, Klinikum Großhadern, University Hospital Munich-Großhadern, Ludwig-Maximillians-University München, Marchioninistr 15, 81377, Munich, Germany

    Christian G. Stief

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  1. Henk van der Poel
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Correspondence to Henk van der Poel.

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Henk van der Poel and Klotz are co-sharing first authorship.

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van der Poel, H., Klotz, L., Andriole, G. et al. Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers. World J Urol 33, 907–916 (2015). https://doi.org/10.1007/s00345-015-1603-7

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