Key papers in prostate cancer

Abstract

Prostate cancer is the most common cancer and second leading cause of death in men. The evidence base for the diagnosis and treatment of prostate cancer is continually changing. We aim to review and discuss past and contemporary papers on these topics to provoke debate and highlight key dilemmas faced by the urological community. We review key papers on prostate-specific antigen screening, radical prostatectomy versus surveillance strategies, targeted therapies, timing of radiotherapy and alternative anti-androgen therapeutics. Previously, the majority of patients, irrespective of risk, underwent radical open surgical procedures associated with considerable morbidity and mortality. Evidence is emerging that not all prostate cancers are alike and that low-grade disease can be safely managed by surveillance strategies and localized treatment to the prostate. The question remains as to how to accurately stage the disease and ultimately choose which treatment pathway to follow.

Keywords::

• localized therapy
• prostate cancer
• radical prostatectomy
• screening
• watchful waiting

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• There is a huge doubt on how best to use prostate-specific antigen in diagnosis and screening of prostate cancer.

• Previously, the majority of prostate cancer was managed by prostatectomy; there is increasing evidence that low-grade disease can be safely managed with surveillance strategies.

• Only with accurate risk stratification of a patient’s disease can active surveillance and localized therapies be considered.

• MRI-fusion systems and 3D mapping template biopsies can potentially accurately risk-stratify a patient’s disease.

• Localized therapies have the advantage of treating just the index lesion and reducing the risk of incontinence and impotence compared with radical prostatectomies.

• There is a need for randomized controlled trial comparing radical with focal treatments.

• Questions still remain as to the timing of radiotherapy and use of new anti-androgen treatments.

• As more evidence emerges, new guidelines will be needed to incorporate the latest developments in prostate cancer investigation and treatment.