Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options

No AccessJournal of UrologyAdult Urology1 Mar 2018Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Optionsis companion ofClinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options Martin G. Sanda, Jeffrey A. Cadeddu, Erin Kirkby, Ronald C. Chen, Tony Crispino, Joann Fontanarosa, Stephen J. Freedland, Kirsten Greene, Laurence H. Klotz, Danil V. Makarov, Joel B. Nelson, George Rodrigues, Howard M. Sandler, Mary Ellen Taplin, and Jonathan R. Treadwell Martin G. SandaMartin G. Sanda More articles by this author , Jeffrey A. CadedduJeffrey A. Cadeddu More articles by this author , Erin KirkbyErin Kirkby Science writer employed by the American Urological Association. More articles by this author , Ronald C. ChenRonald C. Chen More articles by this author , Tony CrispinoTony Crispino More articles by this author , Joann FontanarosaJoann Fontanarosa More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , Kirsten GreeneKirsten Greene More articles by this author , Laurence H. KlotzLaurence H. Klotz More articles by this author , Danil V. MakarovDanil V. Makarov More articles by this author , Joel B. NelsonJoel B. Nelson More articles by this author , George RodriguesGeorge Rodrigues More articles by this author , Howard M. SandlerHoward M. Sandler More articles by this author , Mary Ellen TaplinMary Ellen Taplin More articles by this author , and Jonathan R. TreadwellJonathan R. Treadwell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.11.095AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: This guideline is structured to provide a clinical framework stratified by cancer severity to facilitate care decisions and guide the specifics of implementing the selected management options. The summary presented represents Part I of the two-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline discussing risk stratification and care options by cancer severity. Materials and Methods: The systematic review utilized in the creation of this guideline was completed by the Agency for Healthcare Research and Quality and through additional supplementation by ECRI Institute. This review included articles published between January 2007 and March 2014 with an update search conducted through August 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. Additional information is provided as Clinical Principles and Expert Opinions (table 2 in supplementary unabridged guideline, http://jurology.com/). Results: The AUA (American Urological Association), ASTRO, and SUO (Society of Urologic Oncology) formulated an evidence-based guideline based on a risk stratified clinical framework for the management of localized prostate cancer. Conclusions: This guideline attempts to improve a clinician’s ability to treat patients diagnosed with localized prostate cancer, but higher quality evidence in future trials will be essential to improve the level of care for these patients. In all cases, patient preferences should be considered when choosing a management strategy. References 1 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Google Scholar 2 : Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA1994; 271: 368. Crossref, Medline, Google Scholar 3 : Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol2015; 33: 3379. Google Scholar 4 : Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols. Eur Urol2012; 62: 462. Google Scholar 5 : Is clinical stage T2c prostate cancer an intermediate- or high-risk disease?. Cancer2015; 121: 1414. Google Scholar 6 : A new risk classification system for therapeutic decision making with intermediate risk prostate cancer patients undergoing dose-escalated external-beam radiation therapy. Eur Urol2013; 64: 895. Google Scholar 7 : Number of unfavorable intermediate risk factors predicts pathologic upstaging and prostate cancer-specific mortality following radical prostatectomy: results from the SEARCH database. Prostate2016; 77: 154. Google Scholar 8 : Prognostic value of the new Grade Groups in Prostate Cancer: a multi-insitutional European validation study. Prostate Cancer Prostatic Dis2017; 2: 197. Google Scholar 9 : Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ2002; 325: 961. Google Scholar 10 : Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood)2004; Suppl Variation: VAR63. Google Scholar 11 : Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev2014; 1: CD001431. Google Scholar 12 : Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev2014; 9: CD006732. Google Scholar 13 : Decision aids for localized prostate cancer treatment choice: systematic review and meta-analysis. CA Cancer J Clin2015; 65: 239. Google Scholar 14 : Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev2010; 5: CD006732. Google Scholar 15 : Watchful waiting and quality of life among prostate cancer survivors in the Physicians’ Health Study. J Urol2011; 186: 1862. Link, Google Scholar 16 : Prospective study of determinants and outcomes of deferred treatment or watchful waiting among men with prostate cancer in a nationwide cohort. J Clin Oncol2009; 27: 4980. Google Scholar 17 : 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med2016; 375: 1415. Google Scholar 18 : Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med2012; 367: 203. Google Scholar 19 : Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol2015; 33: 272. Google Scholar 20 : Timing of adverse prostate cancer reclassification on first surveillance biopsy: results from the Canary Prostate Cancer Active Surveillance Study. J Urol2017; 197: 1026. Link, Google Scholar 21 : Reclassification rates are higher among African American men than Caucasians on active surveillance. Urology2015; 85: 155. Google Scholar 22 : African American men with very low risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy: should active surveillance still be an option for them?. J Clin Oncol2013; 31: 2991. Google Scholar 23 : Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med2011; 364: 1708. Google Scholar 24 : Survival among men with clinically localized prostate cancer treated with radical prostatectomy or radiation therapy in the prostate specific antigen era. J Urol2012; 187: 1259. Link, Google Scholar 25 : Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer2010; 116: 5226. Google Scholar 26 : Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy–a propensity scoring approach. J Urol2007; 177: 911. Link, Google Scholar 27 : 13-Year outcomes following treatment for clinically localized prostate cancer in a population based cohort. J Urol2007; 177: 932. Link, Google Scholar 28 : Short- and long-term mortality with localized prostate cancer. Arch Intern Med2007; 167: 1944. Google Scholar 29 : Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol2010; 28: 1508. Google Scholar 30 : Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: a population-based analysis. Int J Urol2012; 19: 836. Google Scholar 31 : Mortality after radical prostatectomy or external beam radiotherapy for localized prostate cancer. J Natl Cancer Inst2013; 105: 711. Google Scholar 32 : A competing risk analysis of cancer-specific mortality of initial treatment with radical prostatectomy versus radiation therapy in clinically localized high-risk prostate cancer. Ann Surg Oncol2014; 21: 4026. Google Scholar 33 : Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ2014; 348: g1502. Google Scholar 34 : Prostate cancer-specific survival differences in patients treated by radical prostatectomy versus curative radiotherapy. Can Urol Assoc J2013; 7: E299. Google Scholar 35 : Radical prostatectomy vs radiotherapy vs observation among older patients with clinically localized prostate cancer: a comparative effectiveness evaluation. BJU Int2014; 113: 200. Google Scholar 36 : Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol2008; 180: 1993. Link, Google Scholar 37 : Ten-year biochemical disease control for patients with prostate cancer treated with cryosurgery as primary therapy. Urology2008; 71: 515. Google Scholar 38 : Prospective trial of cryosurgical ablation of the prostate: five-year results. Urology2002; 60: 645. Google Scholar 39 : Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet2002; 360: 103. Google Scholar 40 : Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med2009; 360: 2516. Google Scholar 41 : Ten-year follow-up of radiation therapy oncology group protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol2008; 26: 2497. Google Scholar 42 : Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet2011; 378: 2104. Google Scholar 43 : Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet2009; 373: 301. Google Scholar 44 : A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer. Cancer2010; 116: 323. Google Scholar 45 : High-intensity focused ultrasound for prostate cancer: a systematic review. Clin Oncol2011; 23: 117. Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPaudel R, Madan R, Qi J, Ferrante S, Cher M, Lane B, George A, Semerjian A and Ginsburg K (2022) The Use and Short-term Outcomes of Active Surveillance in Men With National Comprehensive Cancer Network Favorable Intermediate-risk Prostate Cancer: The Initial Michigan Urological Surgery Improvement Collaborative ExperienceJournal of Urology, VOL. 209, NO. 1, (170-179), Online publication date: 1-Jan-2023.Brant A, Lewicki P, Wu X, Sze C, Johnson J, Basourakos S, Arenas-Gallo C, Shoag D, Barbieri C, Zaorsky N and Shoag J (2022) Impact of Left-Digit Age Bias in the Treatment of Localized Prostate CancerJournal of Urology, VOL. 208, NO. 5, (997-1006), Online publication date: 1-Nov-2022.Filson C, Zhu K, Huang Y, Zheng Y, Newcomb L, Williams S, Brooks J, Carroll P, Dash A, Ellis W, Gleave M, Liss M, Martin F, McKenney J, Morgan T, Wagner A, Sokoll L, Sanda M, Chan D and Lin D (2022) Impact of Prostate Health Index Results for Prediction of Biopsy Grade Reclassification During Active SurveillanceJournal of Urology, VOL. 208, NO. 5, (1037-1045), Online publication date: 1-Nov-2022.Oake J, Shiff B, Harasemiw O, Tangri N, Ferguson T, Bhindi B, Saranchuk J, Bansal R, Drachenberg D and Nayak J (2020) The Comparative Outcomes of Radical Prostatectomy versus Radiotherapy for Nonmetastatic Prostate Cancer: A Longitudinal, Population-Based AnalysisJournal of Urology, VOL. 208, NO. 4, (846-854), Online publication date: 1-Oct-2022.Radhakrishnan A, Wallner L, Skolarus T, George A, Rosenberg B, Abrahamse P and Hawley S (2022) Exploring Variation in the Receipt of Recommended Active Surveillance for Men with Favorable-Risk Prostate CancerJournal of Urology, VOL. 208, NO. 3, (600-608), Online publication date: 1-Sep-2022.Eastham J, Auffenberg G, Barocas D, Chou R, Crispino T, Davis J, Eggener S, Horwitz E, Kane C, Kirkby E, Lin D, McBride S, Morgans A, Pierorazio P, 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on Active Surveillance for Early-Stage Prostate CancerJournal of Urology, VOL. 207, NO. 5, (1001-1009), Online publication date: 1-May-2022.Kim S (2021) Editorial CommentaryUrology Practice, VOL. 9, NO. 2, (139-139), Online publication date: 1-Mar-2022.Dallas K, Taich L, Kuhlmann P, Rogo-Gupta L, Eilber K, Anger J and Scott V (2021) Supracervical Hysterectomy Is Protective against Mesh Complications after Minimally Invasive Abdominal Sacrocolpopexy: A Population-Based Cohort Study of 12,189 PatientsJournal of Urology, VOL. 207, NO. 3, (669-676), Online publication date: 1-Mar-2022.Chen K, Murphy D and Lawrentschuk N (2021) Active Surveillance for Low-Risk Prostate Cancer: The Uphill Battles and the Unnecessary OnesJournal of Urology, VOL. 207, NO. 2, (265-267), Online publication date: 1-Feb-2022.Cooperberg M, Lin D, Morgan T, Chapin B, Chen R and Eggener S (2021) Active Surveillance: Very Much “Preferred” for Low-Risk Prostate CancerJournal of Urology, VOL. 207, NO. 2, (262-264), Online publication date: 1-Feb-2022.Ötleş E, Denton B, Qu B, Murali A, Merdan S, Auffenberg G, Hiller S, Lane B, George A and Singh K (2021) Development and Validation of Models to Predict Pathological Outcomes of Radical Prostatectomy in Regional and National CohortsJournal of Urology, VOL. 207, NO. 2, (358-366), Online publication date: 1-Feb-2022.Lane G, Dupati A, Qi J, Ferrante S, Dunn R, Paudel R, Wittmann D, Wallner L, Berry D, Ellimoottil C, Montie J and Clemens J (2021) Factors Associated with Decision Aid Use in Localized Prostate CancerUrology Practice, VOL. 9, NO. 1, (108-115), Online publication date: 1-Jan-2022.Oake J, Harasemiw O, Tangri N, Ferguson T, Saranchuk J, Bansal R, Drachenberg D and Nayak J (2021) The Association between Income Status and Treatment Selection for Prostate Cancer in a Universal Health Care System: A Population-Based AnalysisJournal of Urology, VOL. 206, NO. 5, (1204-1211), Online publication date: 1-Nov-2021.Cooley L, Emeka A, Meyers T, Cooper P, Lin D, Finelli A, Eastham J, Logothetis C, Marks L, Vesprini D, Goldenberg S, Higano C, Pavlovich C, Chan J, Morgan T, Klein E, Barocas D, Loeb S, Helfand B, Scholtens D, Witte J and Catalona W (2021) Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional CohortJournal of Urology, VOL. 206, NO. 5, (1147-1156), Online publication date: 1-Nov-2021.Radhakrishnan A, Wallner L, Skolarus T, Shahinian V, Abrahamse P, Fetters M and Hawley S (2021) Primary Care Physician Perspectives on Low Risk Prostate Cancer Management: Results of a National SurveyUrology Practice, VOL. 8, NO. 4, (515-522), Online publication date: 1-Jul-2021.Eskra J, Rabizadeh D, Zhang J, Isaacs W, Luo J and Pavlovich C (2021) Specific Detection of Prostate Cancer Cells in Urine by RNA In Situ HybridizationJournal of Urology, VOL. 206, NO. 1, (37-43), Online publication date: 1-Jul-2021.Artenstein D, Kern T, Chen M, Chung J, Jacobsen S and Chien G (2021) 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R, Thalmann G, Virdi J, Winkler M and Ahmed H (2020) Prostate Specific Antigen Criteria to Diagnose Failure of Cancer Control following Focal Therapy of Nonmetastatic Prostate Cancer Using High Intensity Focused UltrasoundJournal of Urology, VOL. 203, NO. 4, (734-742), Online publication date: 1-Apr-2020.Zhou S, Chang E, Patankar A, Huang J, Marks L and Natarajan S (2019) Prostate Cancer Detection Rate of Freehand versus 3-Dimensional Template Mapping Biopsy Using a Magnetic Resonance Imaging-Ultrasound Fusion Device in Biopsy Naïve MenJournal of Urology, VOL. 203, NO. 4, (699-705), Online publication date: 1-Apr-2020.Abedali Z, Calaway A, Large T, Lingeman J, Mellon M and Boris R (2019) The Role of Prostate Specific Antigen Monitoring after Holmium Laser Enucleation of the ProstateJournal of Urology, VOL. 203, NO. 2, (304-310), Online publication date: 1-Feb-2020.Daskivich T, Thomas I, Luu M, Shelton J, Makarov D, Skolarus T and Leppert J (2019) External Validation of the Prostate 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Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options Volume 199Issue 3March 2018Page: 683-690Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsprostateguidelineMetricsAuthor Information Martin G. Sanda More articles by this author Jeffrey A. Cadeddu More articles by this author Erin Kirkby Science writer employed by the American Urological Association. More articles by this author Ronald C. Chen More articles by this author Tony Crispino More articles by this author Joann Fontanarosa More articles by this author Stephen J. Freedland More articles by this author Kirsten Greene More articles by this author Laurence H. Klotz More articles by this author Danil V. Makarov More articles by this author Joel B. Nelson More articles by this author George Rodrigues More articles by this author Howard M. Sandler More articles by this author Mary Ellen Taplin More articles by this author Jonathan R. Treadwell More articles by this author Expand All Advertisement PDF downloadLoading ...