The epidemiology of high-risk prostate cancer

ArticleinCurrent opinion in urology 23(4) · April 2013with10 Reads
DOI: 10.1097/MOU.0b013e328361d48e · Source: PubMed
Purpose of review: Concern for over and under-treatment of men with prostate cancer has led to an increased focus on the identification and selective treatment of men with high-risk features. The purpose of this review is to summarize the epidemiology, risk factors, and treatment trends of men with high-risk prostate cancer. Recent findings: Findings from recent trials on prostate-specific antigen-based screening suggest that screening has substantially reduced the incidence of high-risk prostate cancer. Men with high-risk disease tend to be older at diagnosis than those with low-risk disease. There is marked variation in the treatment of men with high-risk features; contemporary studies favor multimodal therapy, but high-risk disease is often under-treated with androgen deprivation alone, particularly among older men. Summary: Variations in the incidence, mortality, and treatment of men with high-risk prostate cancer may reflect heterogeneity among studies in the definition of high-risk disease. Future research should attempt to standardize definitions of high-risk prostate cancer to allow better comparison between studies and provide a more homogeneous assessment of natural history.
    • "Lowgrade disease (Gleason score of 6, or well differentiated) may remain indolent for more than 10 years; in men with low-risk prostate cancer (low grade and low volume), the risk of disease progression within a decade is less than 6% (Albertsen, 2015). In contrast, about 20%–30% of men are diagnosed with high-risk prostate cancer (Gleason score of 8–10, or poorly differentiated, with a PSA greater than 20), which typically results in death within 10 years (Albertsen, 2015; Punnen & Cooperberg, 2013). Treatment options for localized prostate cancer commonly include surgery, radiation, or active surveillance , and choice of treatment should be tailored to patient preference (Mohler et al., 2010; Wang et al., 2015). "
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