Clinically Localized Prostate Cancer Guidelines

AUA/ASTRO/SUO Guidelines

Following a prostate cancer diagnosis, patients are faced with a multitude of care options, the advisability of which is influenced by patient factors and by cancer severity or aggressiveness. The ability to categorize patients based on cancer aggressiveness is invaluable for facilitating care decisions.

Accordingly, these guidelines for the management of localized prostate cancer are structured first, to provide a clinical framework stratified by cancer severity (or risk group) to facilitate care decisions and second, to guide the specifics of implementing the selected management options.

In Scope: active surveillance, observation/watchful waiting, prostatectomy, radiotherapy, cryosurgery, high intensity focused ultrasound (HIFU) and focal therapy.

Out of Scope: Secondary or salvage treatment for localized prostate cancer that persists or recurs after primary definitive intervention, and primary treatment of locally advanced/metastatic disease.


PSA density vs. PSA level and the prediction of prostate cancer risk

A newly published study in the journal Urology (the “Gold Journal”) has suggested that — at least for patients with a PSA level between 4 and 10 ng/ml — PSA density may be better than PSA level in the determination of which of these patients need to go on to have a biopsy.

  • PSA density was a much more accurate predictor of risk than PSA alone for all men with a PSA level of 4 ng/ml or higher.
  • Among men with a PSA level of < 4 ng/ml, PSA density was no better than PSA at predicting actual prostate cancer (of any type or of clinical significance).


Genomic Testing in Cancer Treatment

Genomic testing is done on cancerous tissue taken from the prostate in order to provide information about how your prostate cancer might behave. By looking at the genetic makeup of the cancer, these tests may help predict whether your prostate cancer grows slowly or aggressively.

Genomic testing can be performed on both biopsy tissue and on tissue from an entire prostate following a prostatectomy.

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Does Proton Beam Therapy for Prostate Cancer Live Up to Its Promise?

Men diagnosed with prostate cancer are faced with an array of prostate treatment options. Proton beam therapy—a form of external beam radiation therapy—is the latest choice now available in the United States. But it’s a controversial option as well, with some critics suggesting that its popularity may be driven by advertising rather than by sound scientific evidence of benefit over other therapies.