Outcomes Following Various Treatment Options for Clinically Localized Prostate Cancer

Kim, Jung Kwon; Joung, Jae Young

Abstract

For the several decades, the treatment of clinically localized prostate cancers has been largely represented by surgery, radiotherapy, and observation. Until recently, this has not changed much. In particular, curative treatment through surgery or radiotherapy is considered to be of no great benefit in elderly patients with low-risk groups. Thus, these strategies are recommended only in moderate or high-risk patients with a life expectancy of 10 years or more. In general, surgery and radiotherapy have been reported to be similar in terms of oncologic outcomes, but the level 1 evidence was lacking to support this to date. Recent advances in imaging modalities have led to the introduction of treatments for the concept of focal therapy, such as high-intensity frequency ultrasound or cryotherapy. Subsequently, positive results have been reported in terms of functional outcomes. However, the level of evidence is not high due to the short follow-up period and the absence of large-scale prospective studies. For the reasons described above, counseling and decision-making were not straightforward. Consequently, the treatment strategy for each individual patient was determined mainly on the risk of incontinence, erectile dysfunction, or other adverse effects of radiotherapy. To overcome these limitations, substantial studies have been reported evaluating survival outcomes and complications following treatments of localized prostate cancer for the past several years. In this review, we aimed to summarize recent literatures on surgery, radiotherapy, and expectant management, which have been the mainstays of treatment for localized prostate cancer; and introduce several treatments for the concept of focal therapy.