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Stage II Prostate Cancer Treatment

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    Baseline PSA and rate of PSA change were associated with subsequent metastasis or prostate cancer death in a cohort of 267 men with clinically localized prostate cancer who were managed by watchful waiting or active surveillance in the control arm of a randomized trial comparing radical prostatectomy to watchful waiting.[3,4] Nevertheless, the accuracy of classifying men into groups whose cancer remained indolent versus those whose cancer progressed was poor at all examined cut points of PSA or PSA rate of change.

    Bisphosphonates and risk of bone metastases

    Patients with locally advanced nonmetastatic disease (T2–T4, N0–N1, and M0) are at risk for developing bone metastases. Bisphosphonates are being studied as a strategy to decrease this risk.

    Evidence (bisphosphonates and risk of bone metastases):

    1. A placebo-controlled, randomized trial (MRC-PR04) of a 5-year regimen of the first-generation bisphosphonate clodronate in high oral doses (2,080 mg per day) had no favorable impact on either time to symptomatic bone metastasis or survival.[5][Level of evidence: 1iA]

    Standard Treatment Options for Stage II Prostate Cancer

    Standard treatment options for stage II prostate cancer include the following:

    1. Watchful waiting or active surveillance.
    2. Radical prostatectomy.
    3. External-beam radiation therapy (EBRT) with or without hormonal therapy.
      • 3-dimensional (3D) conformal radiation therapy.
    4. Interstitial implantation of radioisotopes.

    Watchful waiting or active surveillance

    Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment.[6,7,8] Watch and wait, observation, expectant management, and active surveillance are terms indicating a strategy that does not employ immediate therapy with curative intent. (Refer to the Treatment Option Overview for Prostate Cancer section of this summary for more information).

    Evidence (observation with delayed hormonal therapy):

    1. In a retrospective pooled analysis, 828 men with clinically localized prostate cancer were managed by initial conservative therapy with subsequent hormonal therapy given at the time of symptomatic disease progression.[6]
      • This study showed that the patients with well-differentiated tumors or moderately well-differentiated tumors experienced a disease-specific survival of 87% at 10 years and that their overall survival (OS) closely approximated the expected survival among men of similar ages in the general population.
      • The decision to treat should be made in the context of the patient's age, associated medical illnesses, and personal desires.
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