Management of Prostate Cancer: Global Strategies

As in any malignancy, the management of prostate cancer (pCA) is highly dependent on stage and grade, as well as on the patient's condition. The European Association of Urology (EAU) guidelines on the primary treatment of pCA advise watchful waiting, radical prostatectomy, radiotherapy, hormonal treatment, or a combination of various therapies, depending on the stage and grade of the tumour, as well as the patient's remaining life expectancy and condition. Cytotoxic therapy is recommended for hormone-refractory pCA with metastatic disease. Comparing the results of a survey among urologists on how they treat pCA in clinical practice to the recently updated EAU guidelines shows that the EAU guidelines are followed by the majority of urologists, but these guidelines do not provide guidance for all patients that urologists are confronted with in clinical practice. Considerable variations in practice between urologists were recorded.New data presented at the EAU 2006 annual congress on the use of prostate specific antigen (PSA) in diagnosis/screening, surgery, radiotherapy, hormone therapy, and chemotherapy for the management of pCA is discussed. Whereas the value of serum PSA levels for initial screening is debated, PSA levels in combination with PSA doubling time and PSA velocity may prove more reliable for assessing the presence and severity of pCA. PSA remains important for follow-up after treatment to detect disease recurrence. Several studies on novel surgical techniques including laparoscopic and robot-assisted surgery as well as high-intensity focused ultrasound (HIFU) showed promising results. Data on efficacy and safety of two novel luteinising hormone-releasing hormone antagonists were presented, as well as data comparing intermittent versus continuous hormonal therapy. Furthermore, the beneficial effects of biphosphonates in preventing bone complications in pCA patients on androgen-deprivation therapy and for metastatic disease were highlighted.