Updated treatment guidelines for prostate cancer

This review summarized the 2013 updates to the European Association of Urology’s guidelines on prostate cancer treatment.

Prostate cancer is the most common cancer diagnosed in European men. It is diagnosed more often in elderly men, but increased screening has led to diagnoses in younger men and at earlier stages. The European Association of Urology (EAU) first published guidelines in 2011 for the treatment of different stages of prostate cancer. This review by the EAU analyzed recent research to update their recommendations and guidelines regarding prostate cancer treatment.

Active surveillance, also known as watchful waiting, is recommended for low-risk patients. These patients usually have early-stage (stage 1 or 2) prostate cancer that has not spread beyond the prostate, with low Gleason scores (an indication of how likely it is the cancer will spread based on how prostate cancer cells look under a microscope), and low prostate-specific antigen or PSA (a protein that is elevated in prostate cancer) levels. Patients undergoing active surveillance are not treated, but are closely followed and treated if their disease progresses. One study has shown a 68% 10-year survival (the percentage of patients surviving 10 years after the diagnosis) rate for active surveillance patients.

For patients with low- to intermediate-risk prostate cancer, radical prostatectomy (the curative surgical removal of the prostate) is recommended. Studies show no significant survival differences between active surveillance and radical prostatectomy in low-risk prostate cancer, but in higher-risk patients (those in whom the cancer is likely to reoccur or spread) and in those younger than 65, radical prostatectomy reduced mortality risks by 17.2% compared to patients choosing active surveillance. Radiation therapy is also useful in medium-risk patients, as studies show 94% of patients are recurrence free after 5 years. Radiation can lead to adverse effects, however, such as erectile dysfunction and urinary problems.

There is no general consensus as to the appropriate treatment course for high-risk patients. Radical prostatectomy is used in the majority of patients, but up to 78% require further treatment due to positive margins (indicating the cancer was not fully removed during prostatectomy) or lymph node involvement (cancer that has spread to the lymph nodes). Androgen-deprivation therapy (hormonal therapy) suppresses cancer growth by reducing the levels or blocking the action of testosterone (the main male sex hormone that is responsible for the growth of prostate cancer) on cancer cells. This therapy has been shown to lead to an 80% 10-year survival. Combining androgen-deprivation therapy with radiation therapy significantly decreases mortality and recurrence rates compared to androgen-deprivation therapy alone.

A new treatment, cryosurgical ablation of the prostate, involves freezing the cancerous tissue, which destroys it. Studies show an 8-year overall survival rate of 89% following this treatment.