Intermediate-risk Prostate Cancer-A Sheep in Wolf's Clothing?

This case-based discussion describes a 65-year-old man newly diagnosed with International Society of Urological Pathology (ISUP) grade 2 prostate cancer (PCa). According to the European Association of Urology classification system, the patient harbors an intermediate-risk cancer. In step-by step discussion, we elaborate guideline-based treatment modalities for intermediate-risk PCa focused on debating active surveillance versus active treatment. Thereby, we discuss the importance of patient characteristics, including age, hereditary factors, life expectancy and comorbidity status, findings of multiparametric magnetic resonance imaging, as well as prostate-specific antigen (PSA) density and PSA kinetics, in predicting the clinical course of the disease. In addition, we focus on cribriform pathology as a predictor of adverse outcomes and critically discuss its relevance in patient management. Lastly, we outline genomic stratification in ISUP 2 cancer as a future tool to predict PCa aggressiveness. PATIENT SUMMARY: Based on current guidelines, patients with intermediate-risk prostate cancer are treated actively or can alternatively undergo an active surveillance approach when favorable risk factors are present. One major issue is to discriminate between patients who benefit from an active therapy approach and those who benefit from a deferred treatment. Therefore, reliable biomarkers and early predictors of disease progression are needed urgently.

European urology oncology. 2021 Jul 22 [Epub ahead of print]

Isabel Heidegger, Freddie C Hamdy, Roderick C N van den Bergh, Axel Heidenreich, Michiel Sedelaar, Morgan Roupret, EAU Section of Oncological Urology Board (ESOU)

Department of Urology, Medical University Innsbruck, Innsbruck, Austria. Electronic address: ., Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK., Department of Urology, Antonius Hospital, Utrecht, The Netherlands., Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria., Department of Urology, Radboud University, Medical Center, Nijmegen, The Netherlands., Sorbonne Université, Urology Department, Hôpital Pitié-Salpêtrière, Paris, France.