Clinically Localized Prostate Cancer: Introduction, Risk Assessment, Staging and Risk-Based Management

Patient Guideline Summary

Publication Date: May 10, 2022

Objective

Objective

This patient summary means to discuss key recommendations from the American Urological Association (AUA) and the American Society for Radiation Oncology (ASTRO) for Localized Prostate Cancer – Part I of three. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Prostate cancer is the most common non-cutaneous cancer among US men.
  • Fortunately, the vast majority of cases are diagnosed when they are clinically localized.
  • The early disease has no symptoms. It is diagnosed by physical examination and a blood test for prostate-specific antigen (PSA). Note: the risk to your health from prostate cancer varies widely. Therefore, risk determination is an important step in planning treatment.
  • This patient summary focuses primarily on risk assessment, staging, and risk-based management.

Diagnosis

Diagnosis

  • Risk determination requires a biopsy, a PSA, a T-stage, a Gleason score, and an estimate of tumor volume.
    • A Gleason score is based on the microscopic appearance of the biopsy specimen.
    • Genetic testing may help determine risk.
    • Your general health also contributes to risk.
  • Only high-risk patients should have initial imaging studies to look for distant spread.

Treatment

Treatment

  • Following your risk assessment, you and your treatment team will have a detailed discussion to plan the best treatment course.
    • For low-risk prostate cancer, active surveillance is preferred, periodically re-evaluating your status.
    • For intermediate-risk prostate cancer, treatment choices include active surveillance, radiation, or surgery. There is not enough data for the AUA to make strong recommendations at this point.
    • For higher-risk patients with a life expectancy over 10 years, hormone deprivation (ADT) is an added consideration, since prostate tumors ordinarily require male hormones to grow.
    • Hormone deprivation may also help relieve local symptoms in patients with limited life expectancy.
    • Clinical trials are recommended, if available, for difficult treatment decisions with limited available data.

Abbreviations

  • ADT: Androgen Deprivation Therapy
  • ASTRO: American Society For Radiation Oncology
  • AUA: American Urologic Association
  • PSA: Prostate-specific Antigen

Source Citation

Eastham JA, Auffenberg GB, Barocas DA, Chou R, Crispino T, Davis JW, Eggener S, Horwitz EM, Kane CJ, Kirkby E, Lin DW, McBride SM, Morgans AK, Pierorazio PM, Rodrigues G, Wong WW, Boorjian SA. Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, Part I: Introduction, Risk Assessment, Staging and Risk-Based Management. J Urol. 2022 May 10:101097JU0000000000002757. doi: 10.1097/JU.0000000000002757. Epub ahead of print. PMID: 35536144.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.