From the James E Montie MD, Department of Urology, University of Michigan, Ann Arbor, MI, Michael A. Carducci, MD, Kimmel Cancer Center at Johns Hopkins, Baltimore, MD, Deborah A. Kuban, MD, Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Michael Carducci, MD, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. 1650 Orleans Street, 1M59CRB, Baltimore MD 21231-1000; e-mail: carducci{at}jhmi.edu
Overview: The prevalence of prostate cancer with its lifetime risk of 1:6 men makes it a serious health issue. The need to tailor the treatment to the individual's health and preferences is not quite so compelling for other cancers.1 Multiple divergent opinions by multiple specialists are common, and the medical oncologist is not uncommonly called on to be the arbitrator or unbiased source of "truth." Often, the urologist drives the diagnosis of prostate cancer and guides subsequent management, depending on patient characteristics, tumor characteristics, and availability of various treatment modalities. Active surveillance is increasingly recommended for men with low-burden/low-Gleason prostate cancer. Yet, most of the randomized therapeutic clinical trials for localized prostate cancer employ radiation as the primary modality, attempting to answer questions of radiation dose, field size, and the role of androgen deprivation or adjuvant radiation therapy post prostatectomy. Prostate cancer management is continually changing. In this summary, we seek to provide perspective on some of the changes in the field as well as to discuss some advances in radiation therapy. Increasingly, multidisciplinary management is advocated for patients, particularly those patients with high-risk/high-grade localized prostate cancer.
