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AUA 2017

AUA 2017: AUA/ASTRO/SUO Guidelines 2017: Localized Prostate Cancer Intermediate-Risk

Boston, MA (UroToday.com) Dr. Martin Sanda, from Emory University, presents the new AUA/ASTRO/SUO guidelines for intermediate risk localized prostate cancer. Dr. Sanda starts his discussion introducing the new Gleason grade grouping which has been adopted by the AUA and more recently the WHO. In the new grouping Gleason 7 disease the separated into two distinct groups, group 2 (Gleason 3+4) and group 3 (Gleason 4+3). In the new guidelines intermediate risk prostate cancer is broken in two separate categories “favorable” and “unfavorable” intermediate risk disease. Unfavorable intermediate risk is defined as any patients with group 3 prostate cancer or patients with group 2 prostate cancer presenting with cT2c disease or a PSA between 10-20 ng/dl. For patients in the unfavorable group physicians should consider staging studies to rule out nodal or distant metastatic disease.

In regards to treatment, patients with unfavorable characteristic should be offered radical prostatectomy or radiation therapy with hormone deprivation. In patients with favorable characteristics radiation alone can be considered but with knowledge that the evidence available is less robust than for dual therapy.

In select patients with favorable histology the physician may offer whole gland cryotherapy, but the clinician most counsel on the lack of long-term data and the high possibility for worsening of their baseline voiding symptoms. Active surveillance may also be offered to this group of patients, but the patient must be educated on the higher risk of developing metastasis compared to definitive treatment. Watchful waiting should be offered to intermediate risk patients with a life time expectancy of ≤ 5 years.

Lastly, clinicians should inform patients with intermediate risk prostate cancer who are considering focal therapy or HIFU that these interventions are not standard of care as comparative outcome data is lacking.

A complete summary of the new AUA localized prostate cancer guidelines can be found: http://www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)

Presented By: Martin Sanda, MD, Emory University Department of Urology

Written By: Andres F. Correa, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA