Conservative versus radical therapy of prostate cancer: how have recent advances in molecular markers and imaging enhanced our ability to prognosticate risk?
Recent results of several prospective phase II and phase III trials have reinforced the view that many patients with favorable-risk prostate cancer are over treated. The challenge is to identify those patients who require treatment at a point at which they are still amenable to cure, and to avoid treating those who have indolent disease and those who are incurable. This requires a combination of early detection, accurate imaging, and a selective approach to therapy. The accuracy of serum and tissue biomarkers and new imaging techniques in stratifying patients according to the risk of progression and metastasis is reviewed. The outcome of a strategy of selective intervention in good-risk patients based on prostate-specific antigen (PSA) doubling time is summarized.
Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Scott
S
Bagnall
Laurence
L
Klotz
D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood; D001707:Biopsy, Needle; D018450:Disease Progression; D006133:Growth Substances / Q000097:blood; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013002:Somatomedins / Q000378:metabolism; D020840:Tissue Kallikreins / Q000097:blood; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D014408:Biomarkers, Tumor; D006133:Growth Substances; D013002:Somatomedins; D020840:Tissue Kallikreins; D017430:Prostate-Specific Antigen