Localized Prostate Cancer

Active Surveillance/Watchful Waiting

Active Surveillance

Active Surveillance Protocols

Guideline PSA DRE MRI Biopsy
AUA q3-6mo q12mo Consider using Repeat within 6-12mo
Then q3-5yrs
ASCO Not recommended
EAU q6mo Recommended if rising PSA
NCCN Recommended
Cancer Care Ontario q3-6mo If disconnect between pathology and clinical findings
NICE q3-4mo, adjust per kinetics At enrollment

Watchful Waiting

Focal Therapies

Rationale for Focal Therapy as Treatment

Therapy options

Choosing Surgery (RALP) vs Radiation (XRT)


Surgery XRT
Benefits Removes all cancerous tissue
Confirms diagnosis for upstaging
Salvage XRT "easier" than salvage surgery
No incisions/surgery, no recovery needed
No anesthetic risk
Risks Immediate incontinence, 5-10% persistence at 1yr
Immediate erectile dysfunction (with improvement over time)
Usual surgical risks
Salvage RALP has high complication rate
Worsens baseline LUTS
Acute/delayed GI toxicity
Secondary malignancy

Locally advanced disease (T3-T4)


Considerations for counseling

MSK nomograms

Post-Prostatectomy Incontinence

Post-Prostatectomy Erectile Dysfunction

Postoperative findings

Radiation (XRT)

General XRT options and terms

Risk-Based Options

Risks, Side Effects, and Other Considerations

Biochemical Recurrence


After RALP

After XRT

PSA rise after RALP + XRT (no further local treatment options)

Follow Up




Metastatic disease