Fast Facts: Prostate Cancer
If, when and how to intervene
R.S. Kirby, M.I. Patel, D.M.C. Poon
- 156 pages
- English
- ePUB (mobile friendly)
- Available on iOS & Android
Fast Facts: Prostate Cancer
If, when and how to intervene
R.S. Kirby, M.I. Patel, D.M.C. Poon
About This Book
This is the tenth edition of this Fast Facts handbook since the first was published in 1996 ā the many iterations are testament to the rapid changes in the field and steadily improving outlook for patients. This new edition introduces the Gleason grade grouping (Chapter 1), which has important prognostic value, and nomograms that are used to evaluate risk (Chapter 3). Our understanding of the genetics and underlying pathogenesis of prostate cancer is growing apace, leading to the identification of germline mutations and the development of genomic tests to help identify and direct therapy for those at greatest risk of developing clinically significant disease. They also provide reassurance for those patients who have opted for active surveillance (Chapters 3 and 5). Imaging techniques are also improving rapidly, particularly multiparametric MRI (Chapter 4). As this book is concise, fully up to date and evidence based, we believe it is an ideal resource for those general urologists, primary care providers, specialist nurses, trainees and allied healthcare professionals who want to get quickly up to speed in this fast-moving and ever-expanding field. Contents: ā¢ Epidemiology and pathophysiology ā¢ Diet, lifestyle and chemoprevention ā¢ Screening and early detection ā¢ Diagnosis, staging and prognostic indicators ā¢ Management of clinically localized disease ā¢ Managing recurrence after initial therapy ā¢ Managing metastatic hormone-sensitive prostate cancer ā¢ Management of castrate-resistant prostate cancer ā¢ Survivorship and management of treatment-related side effects and complications
Frequently asked questions
5 | Management of clinically localized disease |
Option | Localized prostate cancer DāAmico* or NCCN risk categoriesā | |||
Low | Intermediate | High | Locally advanced | |
Active surveillance | ā | ā in select cases | ||
Radical prostatectomy | ā | ā | ā | Multimodal therapy |
EBRT | ā | ā | ||
EBRT with androgen deprivation | ā | ā | ā | |
Low-dose seed brachytherapy | ā | ā | ||
Watchful waiting | ā | ā | ā | ā |
Hormonal therapy | ā | ā | ||
Approaches under investigation | ||||
HIFU | ā | ā | ||
Cryotherapy | ā | ā | ||
*See Table 4.1. ā See Table 5.2. HIFU, high-intensity focused ultrasonography; NCCN, (US) National Comprehensive Cancer Network. |
Risk category | TNM stage | Gleason grade group | PSA (ng/mL) | Biopsy results* | PSA density (ng/mL/g) |
Very lowā | T1c | 1 | < 10 | < 3 +ve/< 50% | < 0.15 |
Lowā | T1āT2 | 1 | < 10 | ||
Intermediateā” | T2bāT2c | 2 or 3 | 10ā20 | ||
Highā” | T3a | 4 or 5 | > 20 | ||
*Positive biopsy cores/cancer in each core. ā All criteria apply. ā”One or more factors present. Source: NCCN guidelines, www.nccn.org/professionals/physician_gls/pdf/prostate.pdf, last accessed 30 January 2020. |
Active surveillance
TABLE 5.3 |
Active surveillance criteria |
Consider men with: |
ā¢PSA < 15 ng/mL |
ā¢Gleason grade group 1 (or 2 in select cases) |
ā¢Low volume, < 4 mm of any core and ā¤ 3 of 12 cores involved |
ā¢Life expectancy > 10 years / suitable for radical treatment if progression occurs |
Confirming: |
ā¢3-Tesla mpMRI showing no index or significant lesion |
ā¢Repeat TRUS or transperineal biopsy (if available) within first 6ā12 months shows no upgrading or i... |