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Changing Landscape of Prostate Cancer Favoring Low-Risk Prostate Cancer: Implications for Active Surveillance Versus Focal Therapy

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Imaging and Focal Therapy of Early Prostate Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

PSA screening for prostate cancer has led to stage migration with clinically localized cases comprising over 80 % of new diagnoses. Additional issues raised include overdiagnosis and lead time bias. Traditionally, men diagnosed with localized prostate cancer are counseled to undergo radical treatment such as radical prostatectomy or radiation therapy. However, these modalities are associated with potentially serious lifelong morbidities. Active surveillance and focal therapy have emerged as alternatives in managing low-risk prostate cancer detected by PSA screening with the potential of avoiding the morbidities of radical treatment. In this chapter, we describe the rationale behind utilizing active surveillance or focal therapy, review outcomes of studies for these modalities, and discuss challenges and limitations of each approach. New biomarkers for disease burden, in conjunction with advances in imaging techniques, will solidify active surveillance and focal therapy as powerful new tools in the urologist’s armamentarium for managing localized prostate cancer.

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Authors and Affiliations

  1. Cleveland Clinic, Glickman Urological and Kidney Institute, Q10-1, 9500 Euclid Ave., Cleveland, OH, 44195, USA

    Byron H. Lee M.D., Ph.D. & Eric A. Klein M.D.

  2. Department of Urology, University of California, San Francisco, San Francisco, CA, 94115, USA

    Peter R. Carroll M.D., M.P.H.

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  1. Byron H. Lee M.D., Ph.D.
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  2. Peter R. Carroll M.D., M.P.H.
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  3. Eric A. Klein M.D.
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Correspondence to Byron H. Lee M.D., Ph.D. .

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  1. , Department of Surgery, Duke Cancer Institute, Room 1089 Duke South, Durham, 27710, North Carolina, USA

    Thomas J. Polascik

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Lee, B.H., Carroll, P.R., Klein, E.A. (2013). Changing Landscape of Prostate Cancer Favoring Low-Risk Prostate Cancer: Implications for Active Surveillance Versus Focal Therapy. In: Polascik, T. (eds) Imaging and Focal Therapy of Early Prostate Cancer. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-182-0_2

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  • DOI: https://doi.org/10.1007/978-1-62703-182-0_2

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