Prostate cancer: the new landscape.
OBJECTIVE
This review highlights current features of the changing landscape of the US population with newly diagnosed prostate cancer and discusses new treatment options utilizing noninvasive or minimally invasive management.


RESULTS
Recent evidence of significant changes in the current prostate cancer landscape is based on clinical data and pathological specimens after radical prostatectomy that suggest a further increase of the low-risk patient population that may require reconsideration of treatment options. For a select cohort of patients with low-risk features, based on the D'Amico definition, active surveillance or focal ablative therapy may be a rational alternative to surgical prostatectomy or whole-gland radiation therapy that still dominate as the main treatment approaches for localized prostate cancer.


CONCLUSIONS
As the prostate-specific antigen era continues to mature, we continue to witness stage migration. A growing segment of the localized prostate cancer patient population has very low-volume, low-grade disease. Although active surveillance may be an appropriate approach for a selected group of patients, the progression requiring whole-gland therapy remains a challenge. Organ-sparing focal therapy might ideally fill the gap between a surveillance strategy and whole-gland treatment providing a reasonable balance between cancer control and quality of life.
Moul
Judd W
JW
Division of Urologic Surgery and Duke Prostate Center (DPC), Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. judd.moul@duke.edu
Mouraviev
Vladimir
V
Sun
Leon
L
Schroeck
Florian R
FR
Polascik
Thomas J
TJ
D000367:Age Factors; D042241:Early Diagnosis; D006801:Humans; D008297:Male; D008403:Mass Screening; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy
D017430:Prostate-Specific Antigen