EURURO Vol. 72 No. 2

Review – Prostate Cancer

Low-risk Prostate Cancer: Identification, Management, and

Outcomes

Marco Moschini

a , * ,

Peter R. Carroll

b ,

Scott E. Eggener

c ,

Jonathan I. Epstein

d ,

Markus Graefen

e ,

Rodolfo Montironi

f ,

Christopher Parker

Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy;

Department of Urology, Helen Diller Family Comprehensive Cancer

Center, University of California, San Francisco, CA, USA;

University of Chicago Medical Center, Section of Urology, Chicago, IL, USA;

Johns Hopkins Medical

Institutions, Baltimore, MD, USA;

Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany;

Section of Pathological Anatomy,

Marche Polytechnic University, School of Medicine, United Hospitals, Ancona, Italy;

Academic Urology Unit, The Royal Marsden NHS Foundation Trust and

Institute of Cancer Research, Sutton, Surrey, UK

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 2 3 8 – 2 4 9

available at

www.scienced irect.com

journal homepage:

www.europeanurology.com

Article info

Article history:

Accepted March 3, 2017

Associate Editor:

Giacomo Novara

Keywords:

Prostate cancer

Low risk

EAU

PCa

Active surveillance

Focal therapy

MRI

Radical prostatectomy

EBRT

Biomarkers

Abstract

Context:

The incidence of low-risk prostate cancer (PCa) has increased as a consequence

of prostate-specific antigen testing.

Objective:

In this collaborative review article, we examine recent literature regarding

low-risk PCa and the available prognostic and therapeutic options.

Evidence acquisition:

We performed a literature review of the Medline, Embase, and

Web of Science databases. The search strategy included the terms: prostate cancer, low

risk, active surveillance, focal therapy, radical prostatectomy, watchful waiting, bio-

marker, magnetic resonance imaging, alone or in combination.

Evidence synthesis:

Prospective randomized trials have failed to show an impact of

radical treatments on cancer-specific survival in low-risk PCa patients. Several series

have reported the risk of adverse pathologic outcomes at radical prostatectomy.

However, it is not clear if these patients are at higher risk of death from PCa. Long-

term follow-up indicates the feasibility of active surveillance in low-risk PCa patients,

although approximately 30% of men starting active surveillance undergo treatment

within 5 yr. Considering focal therapies, robust data investigating its impact on long-

term survival outcomes are still required and therefore should be considered experi-

mental. Magnetic resonance imaging and tissue biomarkers may help to predict clini-

cally significant PCa in men initially diagnosed with low-risk disease.

Conclusions:

The incidence of low-risk PCa has increased in recent years. Only a small

proportion of men with low-risk PCa progress to clinical symptoms, metastases, or death

and prospective trials have not shown a benefit for immediate radical treatments. Tissue

biomarkers, magnetic resonance imaging, and ongoing surveillance may help to identify

those men with low-risk PCa who harbor more clinically significant disease.

Patient summary:

Low-risk prostate cancer is very common. Active surveillance has

excellent long-term results, while randomized trials have failed to show a beneficial

impact of immediate radical treatments on survival. Biomarkers and magnetic reso-

nance imaging may help to identify which men may benefit from early treatment.

* Corresponding author. Department of Urology, Urological Research Institute, Vita-Salute Universi-

ty, San Raffaele Scientific Institute/Luzerner Kantonsspital, 30748, Klinik fu¨ r Urologie, Luzern,

Switzerland. Tel. +390226435664; Fax: +390226435664.

E-mail address:

marco.moschini87@gmail.com

(M. Moschini).

http://dx.doi.org/10.1016/j.eururo.2017.03.009

0302-2838/