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Review
. 2022 Oct 17;217(8):424-433.
doi: 10.5694/mja2.51722. Epub 2022 Oct 2.

Modern paradigms for prostate cancer detection and management

Isabella Sc Williams  1 , Aoife McVey  2 , Sachin Perera  1 , Jonathan S O'Brien  2   3 , Louise Kostos  2 , Kenneth Chen  2   4 , Shankar Siva  2   3 , Arun A Azad  2   3 , Declan G Murphy  2   5 , Veeru Kasivisvanathan  2   5 , Nathan Lawrentschuk  1   3 , Mark Frydenberg  6   7
Affiliations
Review

Modern paradigms for prostate cancer detection and management

Isabella Sc Williams et al. Med J Aust. .

Abstract

Early detection and management of prostate cancer has evolved over the past decade, with a focus now on harm minimisation and reducing overdiagnosis and overtreatment, given the proven improvements in survival from randomised controlled trials. Multiparametric magnetic resonance imaging (mpMRI) is now an important aspect of the diagnostic pathway in prostate cancer, improving the detection of clinically significant prostate cancer, enabling accurate localisation of appropriate sites to biopsy, and reducing unnecessary biopsies in most patients with normal magnetic resonance imaging scans. Biopsies are now performed transperineally, substantially reducing the risk of post-procedure sepsis. Australian-led research has shown that prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has superior accuracy in the staging of prostate cancer than conventional imaging (CT and whole-body bone scan). Localised prostate cancer that is low risk (International Society for Urological Pathology [ISUP] grade 1, Gleason score 3 + 3 = 6; and ISUP grade group 2, Gleason score 3 + 4 = 7 with less than 10% pattern 4) can be offered active surveillance, reducing harms from overtreatment. Prostatectomy and definitive radiation remain the gold standard for localised intermediate and high risk disease. However, focal therapy is an emerging experimental treatment modality in Australia in carefully selected patients. The management of advanced prostate cancer treatment has evolved to now include several novel agents both in the metastatic hormone-sensitive and castration-resistant disease settings. Multimodal therapy with androgen deprivation therapy, additional systemic therapy and radiotherapy are often recommended. PSMA-based radioligand therapy has emerged as a treatment option for metastatic castration-resistant prostate cancer and is currently being evaluated in earlier disease states.

Keywords: Chemotherapy; Prostate; Prostatic neoplasms; Radiation oncology; Radiotherapy; Surgical oncology.

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Conflict of interest statement

Declan Murphy has received reimbursement for participation in advisory boards and delivering lectures from Astellas Pharmaceuticals, Janssen Pharma, Bayer, Ipsen, Ferring, and AstraZeneca. Veeru Kasivisvanathan receives funding from Prostate Cancer UK and the John Black Charitable Foundation for unrelated work. Arun Azad has been a consultant for Astellas, Janssen, Novartis, and Aculeus Therapeutics; has participated in speaker bureaus for Astellas, Janssen, Novartis, Amgen, Ipsen, Bristol‐Myers Squibb, Merck Serono, and Bayer; has received honoraria from Astellas, Novartis, Sanofi, AstraZeneca, Tolmar, Telix, Merck, Serono, Janssen, Bristol‐Myers Squibb, Ipsen, Bayer, Pfizer, Amgen, Noxopharm, Merck Sharpe and Dome, and Aculeus Therapeutics; has served on scientific advisory boards for Astellas, Novartis, Sanofi, AstraZeneca, Tolmar, Pfizer, Telix, Merck, Serono, Janssen, Bristol‐Myers Squibb, Ipsen, Bayer, Merck Sharpe and Dome, Amgen, and Noxopharm; has received travel and accommodation expenses from Astellas, Merck Serono, Amgen, Novartis, Janssen, Tolmar, and Pfizer; and has received investigator research funding from Astellas, Merck Serono, and AstraZeneca, and institutional research funding from Bristol‐Myers Squibb, AstraZeneca, Aptevo Therapeutics, GlaxoSmithKline, Pfizer, MedImmune, Astellas, Synthorx, Bionomics, Sanofi Aventis, Novartis, Ipsen, Exelixis, Merck Sharpe and Dome, Janssen, Eli Lilly, and Gilead Sciences. Shankar Siva is supported by a Cancer Council Victoria Colebatch Fellowship; has received grants or contracts from Varian, Reflexion, and Bayer Pharmaceuticals; has received honoraria for speakers’ bureaus from AstraZeneca; is a board member for Radiosurgery Society; is a member of the Genitourinary Working Party of the TransTasman Radiation Oncology Group; and is a member of the advanced radiotherapy technology committee for the International Association for the Study of Lung Cancer.

Figures

None
AS = active surveillance; CT = computed tomography; DRE = digital rectal examination; mpMRI = multiparametric magnetic resonance imaging; PET = positron emission tomography; PSA = prostate‐specific antigen; PSMA = prostate‐specific membrane antigen; TRUS = transrectal ultrasound.
See this image and copyright information in PMC

Comment in

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