Prostate treatment
Searched over 200M research papers for "prostate treatment"
Summary
10 papers analyzed
These studies suggest that prostate cancer treatment should be individualized, with options including radical prostatectomy, external beam radiotherapy, LHRH agonists, androgen deprivation therapy, focal therapy, and active surveillance, depending on the stage and risk level of the disease.
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Prostate Cancer Treatment: Current Approaches and Guidelines
Introduction to Prostate Cancer Treatment
Prostate cancer treatment has evolved significantly over the past decade, with advancements in therapeutic options, imaging techniques, and a better understanding of disease progression. This article synthesizes the latest research and guidelines on the treatment of advanced, relapsing, and castration-resistant prostate cancer (CRPC), as well as localized and locally advanced prostate cancer.
Treatment of Relapsing and Metastatic Prostate Cancer
Androgen Deprivation Therapy (ADT)
Androgen deprivation therapy (ADT) remains the cornerstone for treating metastatic prostate cancer. Luteinizing hormone-releasing hormone (LHRH) agonists and antagonists are commonly used, with the latter potentially offering an oncologic benefit by avoiding testosterone surges . Complete androgen blockade provides a modest survival benefit of about 5% .
Chemotherapy and Novel Agents
For metastatic CRPC, several systemic agents have been approved, including docetaxel, abiraterone acetate plus prednisone (AA/P), enzalutamide, radium-223, and sipuleucel-T . Docetaxel combined with ADT is recommended for men with metastases at first presentation, provided they are fit enough to receive the drug. Second-line treatments following docetaxel include cabazitaxel, AA/P, enzalutamide, and radium-223 .
Imaging and Biopsy
For biochemical failure following radiation therapy, multiparametric magnetic resonance imaging (MRI) and biopsy are crucial for assessment. Imaging techniques like 11C-choline PET/CT and bone scans are recommended based on specific PSA levels .
Treatment of High-Risk Localized and Locally Advanced Prostate Cancer
Primary Treatment Modalities
Radical prostatectomy (RP) and external beam radiotherapy (EBRT) are primary treatment options for high-risk localized and locally advanced prostate cancer. Both treatments are often part of a multimodal approach, potentially combined with postoperative radiotherapy or ADT. High levels of evidence support the addition of long-term ADT or brachytherapy (BT) to EBRT for improved outcomes.
Quality of Life and Functional Outcomes
Quality of life (QoL) and functional outcomes vary between treatments. RP is associated with genitourinary toxicity and sexual dysfunction, while EBRT may lead to bowel problems. Focal therapies like cryoablation, high-intensity focused ultrasound, and brachytherapy offer minimally invasive options with good functional outcomes, though about 10-30% of patients may require transition to conventional whole-gland treatment.
Timing of Androgen Deprivation Therapy
The timing of ADT initiation is crucial. Immediate ADT has been shown to improve overall survival compared to delayed therapy in men with PSA relapse or non-curable prostate cancer. This finding underscores the importance of timely intervention in managing disease progression.
Conclusion
The treatment landscape for prostate cancer is rapidly evolving, with a range of options available depending on the stage and risk profile of the disease. ADT remains a foundational treatment for metastatic prostate cancer, while chemotherapy and novel agents provide additional options for CRPC. For high-risk localized and locally advanced prostate cancer, both RP and EBRT, often as part of a multimodal approach, are effective. The timing of ADT initiation is critical for improving survival outcomes. As research continues, these guidelines will further refine the optimal strategies for managing prostate cancer.
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