Prostate cancer treatment
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Prostate Cancer Treatment: Current Approaches and Advances
Screening and Diagnosis of Prostate Cancer
Prostate cancer (PCa) screening and diagnosis have evolved significantly over the years. The European Association of Urology (EAU) guidelines emphasize that widespread population-based screening using prostate-specific antigen (PSA) is not recommended due to insufficient evidence . Instead, systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic methods . Active surveillance is a viable option for men with low-risk PCa and a long life expectancy, with intervention recommended upon biopsy progression .
Localized Prostate Cancer Treatment
Active Surveillance and Watchful Waiting
For men with localized PCa, active surveillance is recommended for those with low-risk disease, while watchful waiting (WW) is an alternative for those with locally advanced PCa not requiring immediate local treatment . Radical prostatectomy (RP) is the preferred surgical option, especially for patients with a long life expectancy, and nerve-sparing RP is recommended for organ-confined disease .
Radiation Therapy
Radiation therapy is another cornerstone of localized PCa treatment. For low-risk PCa, a dose of ≥74 Gy is recommended, while intermediate- or high-risk PCa requires 78 Gy . Adjuvant androgen deprivation therapy (ADT) for three years is advised for locally advanced disease to improve disease-specific and overall survival rates .
Advanced and Castration-Resistant Prostate Cancer (CRPC)
Androgen Deprivation Therapy (ADT)
Luteinising hormone-releasing hormone (LHRH) agonists are the standard of care for metastatic PCa, while LHRH antagonists may offer an oncologic benefit without causing a testosterone surge . Complete androgen blockade provides a small survival benefit, and intermittent ADT has shown noninferior oncologic efficacy compared to continuous ADT in well-selected populations .
Systemic Therapies
The treatment landscape for advanced PCa has expanded with the approval of several systemic agents. For castration-resistant prostate cancer (CRPC), options include sipuleucel-T, abiraterone acetate plus prednisone (AA/P), and chemotherapy with docetaxel . Second-line treatments following docetaxel include cabazitaxel, enzalutamide, and radium-223 . Zoledronic acid and denosumab are used to prevent skeletal-related complications in men with CRPC and osseous metastases .
Emerging Therapies and Future Directions
Immunotherapy
Immunotherapy is a promising area of research in PCa treatment. Sipuleucel-T is currently the only approved immunotherapy for PCa, showing survival benefits. Other immunotherapies, such as ipilimumab and olaparib, have demonstrated potential but require further research to identify the most beneficial patient populations and disease stages.
Genetic and Biomarker Research
Advances in genomics are playing a crucial role in understanding PCa. Key genetic alterations include fusions of TMPRSS2 with ETS family genes, amplification of the MYC oncogene, and mutations in PTEN and TP53 . Research is ongoing to identify genetic biomarkers for targeted gene therapy and to explore the use of nanotechnology for controlled treatment delivery.
Conclusion
The treatment of prostate cancer is rapidly evolving, with significant advancements in both localized and advanced disease management. Current guidelines emphasize individualized screening and diagnostic approaches, with active surveillance and watchful waiting as viable options for low-risk and locally advanced PCa, respectively. For advanced and castration-resistant PCa, a variety of systemic therapies are available, and ongoing research into immunotherapy and genetic biomarkers holds promise for future treatment strategies. As knowledge in the field continues to grow, these guidelines and treatment options will further refine to improve patient outcomes.
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