From the Guidelines
For a patient with 8mm Gleason 3+4 prostate cancer, the recommended management approach is to discuss and consider active surveillance, radical prostatectomy, and radiation therapy, as these options have been shown to be effective in managing intermediate-risk prostate cancer. According to the most recent guideline evidence 1, patients with favorable intermediate-risk prostate cancer should be offered these treatment options, taking into account factors such as PSA density, tumor volume, and percentage of Gleason pattern 4 disease on biopsy.
Treatment Options
- Active surveillance: involving regular PSA testing every 3-6 months, digital rectal examinations annually, and repeat biopsies every 1-3 years, which may be suitable for select patients with favorable intermediate-risk disease.
- Radical prostatectomy: complete surgical removal of the prostate gland, which can be performed using open, laparoscopic, or robotic-assisted approaches.
- Radiation therapy: including external beam radiation therapy (EBRT) or brachytherapy (seed implantation), with the option to add 4-6 months of androgen deprivation therapy (ADT) for intermediate-risk disease.
Considerations
- The choice between these approaches depends on the patient's age, comorbidities, life expectancy, tumor characteristics, and patient preferences regarding quality of life and potential side effects.
- The ProTecT trial, as referenced in the guideline evidence 1, found that active monitoring was associated with an increased risk of clinical progression and metastatic disease compared to radical prostatectomy or radiotherapy, highlighting the importance of informed shared decision-making.
- While older studies, such as the NCCN clinical practice guidelines 1, provide additional context on the management of high-risk prostate cancer, the most recent guideline evidence 1 prioritizes a personalized approach to managing intermediate-risk disease.
From the Research
Management of Patient with 8mm Gleason 3+4 Prostate Cancer
- The management of a patient with 8mm Gleason 3+4 prostate cancer is a complex decision that involves considering various treatment options, including active surveillance, radical prostatectomy, and radiation therapy 2, 3, 4.
- A study published in the European Urology Oncology journal in 2018 found that patients with Gleason 3+4 prostate cancer had a lower treatment-free survival rate compared to those with Gleason 3+3 prostate cancer 2.
- Another study published in the BJU International journal in 2016 found that the feasibility of active surveillance for low-volume Gleason sum 3+4 disease was comparable to that of Gleason 3+3 disease, but with a higher risk of adverse pathology at radical prostatectomy 4.
- The choice of treatment for patients with Gleason 3+4 prostate cancer should be individualized, taking into account factors such as the patient's age, overall health, and preferences, as well as the specific characteristics of the tumor 5.
- A study published in the JAMA journal in 2018 found that treatment with external beam radiotherapy plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with external beam radiotherapy (EBRT) with androgen deprivation therapy or radical prostatectomy (RP) in patients with Gleason score 9-10 prostate cancer 6.
Treatment Options
- Active surveillance: This involves closely monitoring the patient's condition with regular PSA tests, digital rectal exams, and biopsies, without immediately treating the cancer 2, 4.
- Radical prostatectomy: This is a surgical procedure that involves removing the entire prostate gland and some surrounding tissue 3, 4, 6.
- Radiation therapy: This involves using high-energy rays to kill cancer cells, and can be delivered externally or internally through brachytherapy 3, 6.
- External beam radiotherapy plus brachytherapy boost (EBRT+BT): This is a combination of external beam radiation therapy and internal radiation therapy (brachytherapy) 6.
Factors to Consider
- Patient's age and overall health: These factors can influence the choice of treatment and the patient's ability to tolerate certain therapies 5.
- Tumor characteristics: The size, grade, and stage of the tumor can affect the choice of treatment and the patient's prognosis 2, 4.
- Patient preferences: The patient's values, beliefs, and preferences should be taken into account when making treatment decisions 5.