Clinically Localized Prostate Cancer – Part II: Principles of Active Surveillance, Principles of Surgery, and Follow-Up

Patient Guideline Summary

Publication Date: May 10, 2022

Last Updated: April 29, 2023

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 II of three. It is limited to adults 18 years of age and older and should not be used as a reference for children.

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.

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.

The goal of treatment is cure.

This patient summary focuses on Active Surveillance, Principles of Surgery, and Follow-Up.

Treatment

Active surveillance refers to periodic doctor visits with PSA testing, repeat biopsies and multiparametric magnetic resonance imaging (mpMRI).

Surgery

If you choose radical prostatectomy, every effort will be made to spare nerves near the prostate. Note: these nerves are responsible for sexual function.

Removing nearby lymph nodes is done to stage your cancer but is not documented to affect overall outcome. This decision should be made during a discussion of your surgical options.
- The presence of positive nodes (those containing cancer cells) influences subsequent treatment decisions, notably radiation.

Following surgery, you will be followed for symptoms and PSA tests and encouraged to engage with professional or community support groups.

Abbreviations

ASTRO: American Society For Radiation Oncology
AUA: American Urologic Association
MRI: Magnetic Resonance Imaging
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 II: Principles of Active Surveillance, Principles of Surgery and Follow-up. J Urol. 2022 May 10:101097JU0000000000002758. doi: 10.1097/JU.0000000000002758. Epub ahead of print. PMID: 35536148.

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.