Felix Preisser1, Matthew R Cooperberg2, Juanita Crook3, Felix Feng4, Markus Graefen5, Pierre I Karakiewicz6, Laurence Klotz7, Rodolfo Montironi8, Paul L Nguyen9, Anthony V D'Amico9. 1. Department of Urology, University Hospital Frankfurt, Frankfurt, Germany. Electronic address: felix.preisser@kgu.de. 2. Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA. 3. BCCA Center for the Southern Interior, University of British Columbia, Kelowna, BC, Canada. 4. Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA. 5. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 6. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada. 7. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 8. Section of Pathological Anatomy, Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy. 9. Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Abstract
CONTEXT: Intermediate-risk prostate cancer consists of a highly heterogeneous group of patients. Owing to this heterogeneity and variable prognoses, it is challenging to provide uniform treatment recommendations for men in this group. OBJECTIVE: To review the current literature regarding the best available evidence for stratification and treatment of intermediate-risk prostate cancer patients. EVIDENCE ACQUISITION: We searched Medline and EMBASE, through September 2019 without year or language restriction, supplemented with hand search. EVIDENCE SYNTHESIS: Different treatment options with good long-term oncological outcomes are available for intermediate-risk prostate cancer patients. Best available evidence with long follow-up exists for radical prostatectomy and dose-escalated radiotherapy with short-term androgen deprivation. In favorable intermediate-risk patients, active surveillance and brachy-monotherapy also represent two valid treatment options. In carefully selected men, partial gland ablation represents a reasonable option. Patient preferences and comorbidities should also be considered. CONCLUSIONS: Treatment options for intermediate-risk patients range from active surveillance to partial gland ablation, radical prostatectomy, and various radiotherapy methods. The best stratification and the optimal treatment remain controversial. Classification systems, such as the National Cancer Comprehensive Network guidelines, stratify this large cohort into subgroups with favorable or unfavorable disease, which may simplify treatment recommendations but still leave substantial variability within strata. Advanced imaging may further improve current stratification systems of intermediate-risk patients. PATIENT SUMMARY: In this review, we assessed the current literature regarding the best available evidence for stratification and treatment of intermediate-risk prostate cancer patients.
CONTEXT: Intermediate-risk prostate cancer consists of a highly heterogeneous group of patients. Owing to this heterogeneity and variable prognoses, it is challenging to provide uniform treatment recommendations for men in this group. OBJECTIVE: To review the current literature regarding the best available evidence for stratification and treatment of intermediate-risk prostate cancerpatients. EVIDENCE ACQUISITION: We searched Medline and EMBASE, through September 2019 without year or language restriction, supplemented with hand search. EVIDENCE SYNTHESIS: Different treatment options with good long-term oncological outcomes are available for intermediate-risk prostate cancerpatients. Best available evidence with long follow-up exists for radical prostatectomy and dose-escalated radiotherapy with short-term androgen deprivation. In favorable intermediate-risk patients, active surveillance and brachy-monotherapy also represent two valid treatment options. In carefully selected men, partial gland ablation represents a reasonable option. Patient preferences and comorbidities should also be considered. CONCLUSIONS: Treatment options for intermediate-risk patients range from active surveillance to partial gland ablation, radical prostatectomy, and various radiotherapy methods. The best stratification and the optimal treatment remain controversial. Classification systems, such as the National Cancer Comprehensive Network guidelines, stratify this large cohort into subgroups with favorable or unfavorable disease, which may simplify treatment recommendations but still leave substantial variability within strata. Advanced imaging may further improve current stratification systems of intermediate-risk patients. PATIENT SUMMARY: In this review, we assessed the current literature regarding the best available evidence for stratification and treatment of intermediate-risk prostate cancerpatients.
Authors: Silvia Rodríguez Villalba; Paula Monasor Denia; Maria Jose Pérez-Calatayud; Jose Richart Sancho; Jose Pérez-Calatayud; Antonio Fuster Escrivá; Pedro Torrus Tendero; Manuel Santos Ortega Journal: J Contemp Brachytherapy Date: 2021-04-14
Authors: Adam B Murphy; Michael R Abern; Li Liu; Heidy Wang; Courtney M P Hollowell; Roohollah Sharifi; Patricia Vidal; Andre Kajdacsy-Balla; Marin Sekosan; Karen Ferrer; Shoujin Wu; Marlene Gallegos; Patrice King-Lee; Lisa K Sharp; Carol E Ferrans; Peter H Gann Journal: J Clin Oncol Date: 2021-04-09 Impact factor: 44.544
Authors: Benedikt Hoeh; Rocco Flammia; Lukas Hohenhorst; Gabriele Sorce; Francesco Chierigo; Zhe Tian; Fred Saad; Michele Gallucci; Alberto Briganti; Carlo Terrone; Shahrokh F Shariat; Markus Graefen; Derya Tilki; Luis A Kluth; Philipp Mandel; Felix K H Chun; Pierre I Karakiewicz Journal: Prostate Int Date: 2022-01-26
Authors: Muhammad Hamid; Lance K Heilbrun; Jordan Maier; Kiran Devisetty; Irene Connolly; Isaac Kaufman; Kimberlee Dobson; Mackenzie K Herroon; Daryn Smith; Sandra Sampson; Izabela Podgorski; Elisabeth I Heath Journal: Adv Radiat Oncol Date: 2021-03-03
Authors: Mike Wenzel; Felix Preisser; Benedikt Hoeh; Maria N Welte; Clara Humke; Clarissa Wittler; Christoph Würnschimmel; Andreas Becker; Pierre I Karakiewicz; Felix K H Chun; Philipp Mandel; Luis A Kluth Journal: Front Surg Date: 2021-12-09