The prostate cancer field has been changing rapidly over the past two decades since the introduction and widespread use of the prostate-specific antigen (PSA). The increase in the number of cases diagnosed with prostate cancer that occurred as a result of screening necessitated refinements of existing therapies and the development of novel approaches. More recently, a greater appreciation of a role for active surveillance for selected patients has also developed. The primary oncologist should play a central role in helping patients make educated decisions about therapy (to treat or not and what is optimal therapy for the individual patient). The changes in the field have been staggering, and the literature can be confusing. This monograph updates the reader on developments in the field, providing a balanced, state-of-the-art assessment of treatment of early prostate cancer. It updates the reader on established forms of therapy, including external beam radiotherapy (EBRT) and brachytherapy, the evolving role of minimally invasive surgery and combination therapies, and, finally, on future directions. In his chapter, Dr. Mack Roach from the University of California at San Francisco gives us his perspective on the role of brachytherapy in early prostate cancer; in particular, in the area of patient selection. In his comprehensive discussion of external beam radiation, he focuses his attention on trials that have demonstrated that survival and/or biochemical (PSA) control rates are improved with the addition of either short-term or long-term androgen-deprivation therapy (ADT) to EBRT, on trials that have demonstrated that biochemical control rates can be improved with the use of higher doses of radiation, and on the emerging role of three-dimensional conformal radiation or intensity- modulated radiotherapy techniques, which permit the delivery of high doses of radiation safely. Dr. Hu and colleagues from the Brigham and Women’s Hospital review the latest in different techniques for performing radical prostatectomy, including minimally invasive surgery, an increasingly popular approach. Although this is a rapidly evolving field, the oncologist needs to be aware of the latest in these approaches. The next two chapters explore integrated approaches. Dr. Sartor from the Dana-Farber Cancer Institute builds on Dr. Roach’s chapter with a thorough review of the different forms of ADT, the evolving appreciation of side effects of ADT, and the role of ADT in early disease in particular when used in conjunction with radiation. He points out, however, the failure of ADT to provide a benefit when used before surgery. Finally, he discusses the potential role of adjuvant ADT in high-risk patients; currently the subject of clinical trials. Drs. Febbo and George from Duke University review the integration of chemotherapy into early prostate cancer treatment. Many small trials have been conducted, and we await the results of the trials that are well outlined in this chapter. Finally, looking to the future of therapy for prostate cancer, the last chapter reviews some of the agents under investigation, which, if they prove to be efficacious, may find their way into the multimodality management of early disease. It is hoped that this monograph gives the practicing oncologist useful and current information to help guide patients through the difficult decision-making process surrounding the diagnosis of early prostate cancer.
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