Prostate Cancer Prevalence

In active surveillance, patients are monitored closely and treatment such as surgery or radiation therapy is deferred unless there is growth or progression of cancer. This approach is only applicable to a small proportion of low-grade cancers.

Surgery involves removing the prostate and the surrounding tissues completely. This includes removal of the surrounding lymph nodes, especially for high-grade cancers. The gold standard surgical option nowadays is robot-assisted radical prostatectomy. Two of the main long-term side effects of surgery are erectile dysfunction and urinary incontinence.

Radiation therapy involves utilising high doses of radiation to kill prostate cancer cells. The most commonly used type of radiation therapy for prostate cancer is called external beam radiation therapy (EBRT), in which a machine aims radiation at the cancer from outside the body. It is considered as effective as surgery for the treatment of localised prostate cancer, and is the standard alternative in all the prostate cancer treatment guidelines. Potential downsides to radiation therapyinclude longer treatment duration and risk of damage to surrounding organs.

With the advent of more accurate MRI-targeted prostate biopsies in the last few years, some patients are diagnosed with cancer only involving a small proportion of the prostate. In these men, the logical thought is whether treatment can be focused only on these areas of cancer without needing whole gland treatment.
This is also known as focal therapy as only the region of the prostate where the cancer is located is treated. This approach can potentially improve the functional outcomes of treatment (i.e., lower the risk of urine incontinence and erectile dysfunction) without sacrificing control of the cancer that is achieved with whole gland treatment. Focal therapy is a new approach to treating prostate cancer, and as such the studies have follow up of less than 10 years after treatment. However, it is still not considered standard of care and more information is needed about long term outcomes from this approach.