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May 2023 | Autored by: George M. Pikler, M.D., Ph.D., FACP

Localized Prostate Cancer: Current Status on Screening and Treatment

Prostate cancer is currently the most diagnosed cancer (excluding non-melanoma skin cancer) and the second leading cause of cancer death among U.S. men. In 2022, an estimated 268,500 men were diagnosed with prostate cancer and approximately 34,500 died of it. (1) In the majority of these patients, the disease is found to be localized, with only approximately 7% of patients presenting with metastatic disease. In the past decade, active surveillance (AS) -periodic surveillance biopsies in addition to PSA monitoring- has emerged as an alternative to immediate, definitive therapy (radiation therapy or radical prostatectomy) for men with localized, low-risk disease and for selected persons with favorable, intermediate-risk disease. (2-3) The side effects of radical prostatectomy and radiation therapy are well known and can also include substantial sexual or urinary dysfunction. In a recently reported study (4) men with localized disease were randomly assigned to one of three arms: AS, prostatectomy, or radiotherapy. At a median follow-up of 15 years, there was no difference in prostate cancer mortality between the groups. Survival for all three groups was high — 97% regardless of treatment approach. The current best practice in AS includes the use of multiparametric magnetic resonance (MRI) to avoid DRE and as the first assessment for changes in PSA, with omission of repeat standard biopsy when PSA and MRI are stable. (5-6)

(1) National Cancer Institute. Cancer stat facts: common cancer sites. Surveillance, Epidemiology, and End Results Program. 2022
(2) Eur Urol Oncol 2022; 5:617-627
(3) World J Urol 2022; 40:35-42
(4) N Engl J Med 2023; 388: 1547-1558
(5) Eur Urol Oncol. 2023 Apr; 6(2): 160-182
(6) N Engl J Med 2023; 388:1617-1618
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.