2023 Update On the Screening and Treatment of Localized Prostate Cancer

Authors

  • Wee Loon Ong, MD Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON; Alfred Health Radiation Oncology, Monash University, Melbourne, Australia
  • Andrew Loblaw, MD, FRCPC Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Radiation Oncology, University of Toronto; Department of Health Policy, Measurement and Evaluation, University of Toronto

DOI:

https://doi.org/10.58931/cpct.2023.1318

Abstract

Prostate cancer represents a major burden of disease in Canada. It represents the third leading cause of cancer mortality in men with more than 24,000 individuals diagnosed in 2021. The diagnosis and management of prostate cancer is a continuously evolving area, and the aim of this article is to provide current information on various aspects of prostate cancer care, as an aid for primary care physicians (PCPs) as they guide men through the prostate cancer journey.

Author Biographies

Wee Loon Ong, MD, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON; Alfred Health Radiation Oncology, Monash University, Melbourne, Australia

Dr. Wee Loon Ong is an Australian-trained radiation oncologist. He undertook further fellowship training in genitourinary cancers at the Sunnybrook Odette Cancer Centre, University of Toronto. He has an MPhil in Epidemiology from the University of Cambridge. His clinical and research interests are primarily on prostate cancer, including both stereotactic radiotherapy and brachytherapy. He has authored over 50 peer-reviewed publications.

Andrew Loblaw, MD, FRCPC, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Radiation Oncology, University of Toronto; Department of Health Policy, Measurement and Evaluation, University of Toronto

Dr. Andrew Loblaw is a Radiation Oncologist, Clinician Scientist, Site Group Co-Lead for Genitourinary Oncology and Professor in the Department of Radiation Oncology at Sunnybrook Health Sciences Centre. Dr. Loblaw’s clinical practice and research interest focus on improving outcomes for men with prostate cancer and the healthcare system. A Fellow of the American Society of Clinical Oncology (FASCO), he was previous Co-Chair of the ASCO’s Genitourinary Advisory Group and remains Co-Chair of the GU group for Cancer Care Ontario’s Program in Evidence-Based Care. He has authored over 300 peer-reviewed papers and has been awarded grant funding of over $52M.

References

Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, Kwiatkowski M, Lujan M, Lilja H, Zappa M, Denis LJ. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009 Mar 26;360(13):1320-8. DOI: https://doi.org/10.1056/NEJMoa0810084

de Vos II, Meertens A, Hogenhout R, Remmers S, Roobol MJ; ERSPC Rotterdam Study Group. A Detailed Evaluation of the Effect of Prostate-specific Antigen–based Screening on Morbidity and Mortality of Prostate Cancer: 21-year Follow-up Results of the Rotterdam Section of the European Randomised Study of Screening for Prostate Cancer. Eur Urol. Epub 2023 Apr 5. DOI: https://doi.org/10.1016/j.eururo.2023.03.016

Hendrick RE, Helvie MA. Mammography screening: a new estimate of number needed to screen to prevent one breast cancer death. Am J Roentgenol. 2012 Mar;198(3):723-8. DOI: https://doi.org/10.2214/AJR.11.7146

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer LJ, Ueffing E, MacDonald NE, Hassan G. Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2011 Sep 6;183(12):E824-925. Epub 2010 Jun 7. DOI: https://doi.org/10.1503/cmaj.090313 DOI: https://doi.org/10.1503/cmaj.090313

Andriole GL, Crawford ED, Grubb III RL, Buys SS, Chia D, Church TR, Fouad MN, Gelmann EP, Kvale PA, Reding DJ, Weissfeld JL. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009 Mar 26;360(13):1310-9. DOI: https://doi.org/10.1056/NEJMoa0810696

Shoag JE, Mittal S, Hu JC. Reevaluating PSA testing rates in the PLCO trial. N Engl J Med. 2016 May 5;374(18):1795-6. DOI: https://doi.org/10.1056/NEJMc1515131

Hugosson J, Roobol MJ, Månsson M, Tammela TL, Zappa M, Nelen V, Kwiatkowski M, Lujan M, Carlsson SV, Talala KM, Lilja H. A 16-yr Follow-up of the European randomized study of screening for prostate Cancer. Eur Urol. 2019 Jul 1;76(1):43-51. DOI: https://doi.org/10.1016/j.eururo.2019.02.009

Remmers S, Bangma CH, Godtman RA, Carlsson SV, Auvinen A, Tammela TL, Denis LJ, Nelen V, Villers A, Rebillard X, Kwiatkowski M. Relationship Between Baseline Prostate-specific Antigen on Cancer Detection and Prostate Cancer Death: Long-term Follow-up from the European Randomized Study of Screening for Prostate Cancer. Eur Urol. 2023 Apr 21:S0302-2838(23)02709-4.

Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, Briganti A, Budäus L, Hellawell G, Hindley RG, Roobol MJ. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018 May 10;378(19):1767-77. DOI: https://doi.org/10.1056/NEJMoa1801993

Klotz L, Chin J, Black PC, Finelli A, Anidjar M, Bladou F, Mercado A, Levental M, Ghai S, Chang SD, Milot L. Comparison of multiparametric magnetic resonance imaging–targeted biopsy with systematic transrectal ultrasonography biopsy for biopsy-naive men at risk for prostate cancer: a phase 3 randomized clinical trial. JAMA Oncology. 2021 Apr 1;7(4):534-42. DOI: https://doi.org/10.1001/jamaoncol.2020.7589

Haider MA, Brown J, Chin JL, Perlis N, Schieda N, Loblaw A. Evidence-based guideline recommendations on multiparametric magnetic resonance imaging in the diagnosis of clinically significant prostate cancer: A Cancer Care Ontario updated clinical practice guideline. Can Urol Assoc J. 2022 Feb;16(2):16. DOI: https://doi.org/10.5489/cuaj.7425

Grummet J, Gorin MA, Popert R, O’Brien T, Lamb AD, Hadaschik B, Radtke JP, Wagenlehner F, Baco E, Moore CM, Emberton M. “TREXIT 2020”: why the time to abandon transrectal prostate biopsy starts now. Prostate Cancer Prostatic Dis. 2020 Mar;23(1):62-5. DOI: https://doi.org/10.1038/s41391-020-0204-8

Stefanova V, Buckley R, Flax S, Spevack L, Hajek D, Tunis A, Lai E, Loblaw A. Transperineal prostate biopsies using local anesthesia: experience with 1,287 patients. Prostate cancer detection rate, complications and patient tolerability. J Urol. 2019 Jun;201(6):1121-6. DOI: https://doi.org/10.1097/JU.0000000000000156

Gorin MA, Meyer AR, Zimmerman M, Harb R, Joice GA, Schwen ZR, Allaf ME. Transperineal prostate biopsy with cognitive magnetic resonance imaging/biplanar ultrasound fusion: description of technique and early results. World Journal of Urology. 2020 Aug;38:1943-9. DOI: https://doi.org/10.1007/s00345-019-02992-4

Hossack T, Patel MI, Huo A, Brenner P, Yuen C, Spernat D, Mathews J, Haynes AM, Sutherland R, Del Prado W, Stricker P. Location and pathological characteristics of cancers in radical prostatectomy specimens identified by transperineal biopsy compared to transrectal biopsy. J Urol. 2012 Sep 1;188(3):781-5. DOI: https://doi.org/10.1016/j.juro.2012.05.006

Hamdy FC, Donovan JL, Lane JA, Metcalfe C, Davis M, Turner EL, Martin RM, Young GJ, Walsh EI, Bryant RJ, Bollina P. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2023 Apr 27;388(17):1547-58. DOI: https://doi.org/10.1056/NEJMoa2214122

Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, et al. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 2014;370(10):932-42. DOI: https://doi.org/10.1056/NEJMoa1311593

Wilt TJ, Jones KM, Barry MJ, Andriole GL, Culkin D, Wheeler T, Aronson WJ, Brawer MK. Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med. 2017 Jul 13;377(2):132-42. DOI: https://doi.org/10.1056/NEJMoa1615869

Morash C, Tey R, Agbassi C, Klotz L, McGowan T, Srigley J, Evans A. Active surveillance for the management of localized prostate cancer: guideline recommendations. Can Urol Assoc J. 2015 Jun 15;9(5-6):171-8. DOI: https://doi.org/10.5489/cuaj.2806

Chen RC, Rumble B, Loblaw A, Finelli A, Ehdaie B, Cooperberg MR, Morgan SC, Tyldesley S, Haluschak JJ, Tan W, Justman S. Active surveillance for the management of localized prostate cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2016 Jun;34(18):2182-90. DOI: https://doi.org/10.1200/JCO.2015.65.7759

Pattenden TA, Samaranayke D, Morton A, Ong WL, Murphy DG, Pritchard E, Evans S, Millar J, Chalasani V, Rashid P, Winter M. Modern active surveillance in prostate cancer: a narrative review. Clin Genitourin Cancer. Epub 2022 Sep 8. DOI: https://doi.org/10.1016/j.clgc.2022.09.003

Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33(3):272-7. DOI: https://doi.org/10.1200/JCO.2014.55.1192

Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008 Mar 20;358(12):1250-61. DOI: https://doi.org/10.1056/NEJMoa074311

Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425-37. DOI: https://doi.org/10.1056/NEJMoa1606221

Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M, Guazzoni G, Menon M, Mottrie A, Patel VR, Van der Poel H. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol. 2012 Sep 1;62(3):418-30. DOI: https://doi.org/10.1016/j.eururo.2012.05.046

Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, Menon M, Montorsi F, Patel VR, Stolzenburg JU, Van der Poel H. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012 Sep 1;62(3):405-17. DOI: https://doi.org/10.1016/j.eururo.2012.05.045

Tree AC, Ostler P, van der Voet H, Chu W, Loblaw A, Ford D, Tolan S, Jain S, Martin A, Staffurth J, Armstrong J. Intensity-modulated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): 2-year toxicity results from an open-label, randomized, phase 3, non-inferiority trial. Lancet Oncol. 2022 Oct 1;23(10):1308-20. DOI: https://doi.org/10.1016/S1470-2045(22)00517-4

van As N, Tree A, Ostler P, van der Voet H, Ford D, Tolan S, et al. PACE-A: An international phase 3 randomized controlled trial (RCT) comparing stereotactic body radiotherapy (SBRT) to surgery for localized prostate cancer (LPCa)—Primary endpoint analysis. J Clin Oncol. 2023;41(Suppl 6):298. DOI: https://doi.org/10.1200/JCO.2023.41.6_suppl.298

Kishan AU, Karnes RJ, Romero T, Wong JK, Motterle G, Tosoian JJ, Trock BJ, Klein EA, Stish BJ, Dess RT, Spratt DE. Comparison of multimodal therapies and outcomes among patients with high-risk prostate cancer with adverse clinicopathologic features. JAMA Network Open. 2021 Jul 1;4(7):e2115312. DOI: https://doi.org/10.1001/jamanetworkopen.2021.15312

Corkum MT, Loblaw DA, Morton G, Louie AV, Glicksman R, Chin J, Kulkarni G, Dinniwell RE, Fisher B, Saskin R, Warner A. Radiation oncologist consultations prior to radical prostatectomy: Disparities and opportunities. J Urol. 2022 Jan;207(1):118-26. DOI: https://doi.org/10.1097/JU.0000000000002187

Published

2023-10-25

How to Cite

1.
Ong WL, Loblaw A. 2023 Update On the Screening and Treatment of Localized Prostate Cancer. Can Prim Care Today [Internet]. 2023 Oct. 25 [cited 2024 May 22];1(3):4-7. Available from: https://canadianprimarycaretoday.com/article/view/1-3-ong_loblaw

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