title: Management of low (favourable)-risk prostate cancer.
abstract: What's known on the subject? and What does the study add? Most men who are diagnosed with favourable-risk prostate cancer undergo some form of active intervention, despite evidence that treatment will not improve health outcomes for many. The decision to undergo treatment after diagnosis is, in part, related to the inability to precisely determine the long-term risk of harm without treatment. Nevertheless, physicians should consider patient age, overall health, and preferences for living with cancer and the potential side effects of curative treatments, before recommending a management option. This is especially important for older men, given the high level of evidence that those with low-risk disease are unlikely to accrue any benefit from curative intervention. What is known on the subject: Over treatment of favourable-risk prostate cancer is common, especially among older men. What does the study add: A review of the natural history of favourable-risk prostate cancer in the context of choices for management of the disease. • The management of favourable-risk prostate cancer is controversial, and in the absence of controlled trials to inform best practice, choices are driven by personal beliefs with resultant wide variation in practice patterns. • Men with favourable-risk prostate cancer diagnosed today often undergo treatments that will not improve overall health outcomes. • A shared-decision approach for selecting optimal management of favourable-risk disease should account for patient age, overall health, and preferences for living with cancer and the potential side effects of curative treatments.
authors.affiliation: Department of Urology, Johns Hopkins Hospital, Baltimore, MD 21287-2101, USA. hcarter@jhmi.edu
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
mesh_terms: D000368:Aged; D019317:Evidence-Based Medicine; D005544:Forecasting; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000097:blood / Q000209:etiology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D019564:Unnecessary Procedures; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen
references.citation: Cancer. 2010 Mar 1;116(5):1281-90
references.pmid: 20066716
references.citation: Lancet Oncol. 2010 Aug;11(8):725-32
references.pmid: 20598634
references.citation: J Natl Cancer Inst. 2003 Jun 18;95(12):868-78
references.pmid: 12813170
references.citation: JAMA. 2009 Sep 16;302(11):1202-9
references.pmid: 19755699
references.citation: J Clin Oncol. 2009 Oct 20;27(30):4980-5
references.pmid: 19720918
references.citation: J Urol. 2008 Jul;180(1):150-4; discussion 154
references.pmid: 18485398
references.citation: J Natl Cancer Inst. 2006 Aug 16;98(16):1134-41
references.pmid: 16912266
references.citation: N Engl J Med. 2010 Nov 4;363(19):1822-32
references.pmid: 21047226
references.citation: Urol Oncol. 2009 May-Jun;27(3):246-50
references.pmid: 19414112
references.citation: J Urol. 2008 Mar;179(3):901-4; discussion 904-5
references.pmid: 18207195
references.citation: J Urol. 2010 Jul;184(1):131-5
references.pmid: 20478589
references.citation: Lancet Oncol. 2011 Feb;12(2):122
references.pmid: 21355130
references.citation: J Urol. 2011 Mar;185(3):869-75
references.pmid: 21239008
references.citation: J Natl Cancer Inst. 2007 Oct 3;99(19):1484-9
references.pmid: 17895474
references.citation: Urology. 2010 Sep;76(3):695-700
references.pmid: 20394969
references.citation: J Urol. 2007 Sep;178(3 Pt 2):S14-9
references.pmid: 17644125
references.citation: Br J Cancer. 2006 May 22;94(10):1361-8
references.pmid: 16641912
references.citation: J Natl Compr Canc Netw. 2010 Feb;8(2):162-200
references.pmid: 20141676
references.citation: N Engl J Med. 2009 Mar 26;360(13):1310-9
references.pmid: 19297565
references.citation: J Natl Cancer Inst. 2006 Jun 21;98(12):839-45
references.pmid: 16788157
references.citation: J Natl Cancer Inst. 2010 Jul 7;102(13):950-8
references.pmid: 20562373
references.citation: Cancer. 2008 Apr 15;112(8):1650-9
references.pmid: 18306379
references.citation: J Urol. 2010 May;183(5):1779-85
references.pmid: 20304433
references.citation: J Natl Cancer Inst. 2010 May 5;102(9):605-13
references.pmid: 20413742
references.citation: Cancer Causes Control. 2008 Mar;19(2):175-81
references.pmid: 18027095
references.citation: J Clin Oncol. 2010 Jan 1;28(1):126-31
references.pmid: 19917860
references.citation: Lancet Oncol. 2011 Mar;12(3):245-55
references.pmid: 21310658
references.citation: N Engl J Med. 2009 Mar 26;360(13):1320-8
references.pmid: 19297566
references.citation: World J Urol. 2011 Jun;29(3):303-9
references.pmid: 21331629
references.citation: JAMA. 2005 May 4;293(17):2095-101
references.pmid: 15870412
references.citation: Arch Intern Med. 2010 Mar 8;170(5):450-2
references.pmid: 20212181
references.citation: J Natl Cancer Inst. 2009 Oct 7;101(19):1325-9
references.pmid: 19720969
references.citation: J Clin Oncol. 2011 Apr 1;29(10):1335-41
references.pmid: 21357791
references.citation: Curr Opin Support Palliat Care. 2009 Sep;3(3):166-9
references.pmid: 19553817
references.citation: Arch Intern Med. 2010 Jul 26;170(14):1256-61
references.pmid: 20660846
references.citation: J Natl Cancer Inst. 1995 Apr 5;87(7):532-4
references.pmid: 7707440
references.citation: Med Care. 2011 Apr;49(4):333-9
references.pmid: 21368677
references.citation: N Engl J Med. 2004 May 27;350(22):2239-46
references.pmid: 15163773
references.citation: J Natl Cancer Inst. 2011 Feb 16;103(4):290-2
references.pmid: 21303995
references.citation: N Engl J Med. 2008 Mar 20;358(12):1250-61
references.pmid: 18354103
references.citation: Eur Urol. 2010 Nov;58(5):687-700
references.pmid: 20727668
references.citation: Curr Opin Urol. 2009 May;19(3):258-62
references.pmid: 19295434
references.citation: J Urol. 2009 Apr;181(4):1628-33; discussion 1633-4
references.pmid: 19233388
references.citation: JAMA. 1998 Sep 16;280(11):969-74
references.pmid: 9749478
references.citation: J Clin Oncol. 2011 Jun 1;29(16):2185-90
references.pmid: 21464416
references.citation: J Urol. 2010 Oct;184(4):1322-7
references.pmid: 20723940
references.citation: J Natl Cancer Inst. 2008 Aug 20;100(16):1144-54
references.pmid: 18695132
references.citation: Eur J Cancer. 2010 Nov;46(17):3095-101
references.pmid: 21047592
references.citation: Cancer. 2009 Jul 1;115(13 Suppl):3039-45
references.pmid: 19544545
references.citation: J Clin Oncol. 2010 Mar 1;28(7):1117-23
references.pmid: 20124165
references.citation: Lancet. 2009 Jan 24;373(9660):301-8
references.pmid: 19091394
references.citation: Nature. 2011 Feb 10;470(7333):269-73
references.pmid: 21289624
references.citation: J Urol. 2009 Apr;181(4):1635-41; discussion 1641
references.pmid: 19233410
references.citation: JAMA. 2010 Dec 1;304(21):2373-80
references.pmid: 21119084
references.citation: J Natl Cancer Inst. 2005 Sep 7;97(17):1248-53
references.pmid: 16145045
references.citation: J Health Econ. 2005 Sep;24(5):891-906
references.pmid: 16129128
references.citation: N Engl J Med. 2010 Aug 19;363(8):701-4
references.pmid: 20818872
references.citation: JAMA. 1994 Feb 2;271(5):368-74
references.pmid: 7506797
references.citation: Ann Intern Med. 2008 Mar 18;148(6):435-48
references.pmid: 18252677
references.citation: J Urol. 2011 Feb;185(2):471-6
references.pmid: 21167525
references.citation: Contemp Clin Trials. 2009 Jan;30(1):81-7
references.pmid: 18783735
references.citation: BJU Int. 2011 Feb;107(4):576-84
references.pmid: 20735387
references.citation: BJU Int. 2010 Oct;106(8):1161-4
references.pmid: 20456339
references.citation: J Nucl Med. 2009 Sep;50(9):1387-90
references.pmid: 19690043
references.citation: Eur Urol. 2011 Jan;59(1):61-71
references.pmid: 21056534