Editing AUA: Clinically Localized Prostate Cancer (2017) (section)

== Answers ==

# Describe the risk classification of clinically localized prostate cancer.
## Very low-risk: low-risk + PSA density <0.15, <34% cores positive, no more than 50% of one core
## Low-risk: PSA<10, cT2a, GG1
## Intermediate-risk: PSA 10-20, cT2b/c, GG2 or 3
#** Favourable: GG1 and PSA 10-20 or GG2 and PSA <10
## High-risk: PSA >20, cT3, GG4-5
# Which patients with clinically localized prostate cancer should undergo staging investigations?
## High-risk and intermediate-risk patients with 2 of: Gleason 7, palpable tumour on DRE, PSA 10-20
# When is a lymph node dissection indicated in patients undergoing radical prostatectomy for clinically localized prostate cancer?
## Intermediate-risk, unfavourable
## High-risk
# What are the preferred treatment options by risk category in clinically localized prostate cancer?
## WW if life expectancy ≤5 years
## Very-low risk: AS
## Low-risk: AS
## Intermedite-risk: RP, EBRT + 6 mo ADT, brachy, or EBRT + brachy + 6 mo ADT
## High-risk: RP, EBRT + 24-36 months brachy, HDR brachy
# What are risk factors for reclassification on subsequent biopsy during active surveillance?
## Obesity
## African American race
## PSA density > 0.15
## Extensive Gleason 6 cancer on systematic biopsy cores
# Describe the follow-up on patients managed with AS?
## PSA every 3-6 months
## DRE each year
## Systematic biopsies within 6-12 months after the diagnostic biopsy, and then every 3-5 years until the patient is ‘switched’ to watchful waiting
# What is the management of a symptomatic lymphocele following radical prostatectomy?
## Percutaneous drain à sclerosing agent à marsupialization
# What are contraindications to radiotherapy for localized prostate cancer?
## Size > 60g for brachy
## TURP for brachy
## LUTS severe
## IBD
## Ataxia telengectasia
## Radiation pelvic
# What is PSA value is considered treatment success in clinically localized prostate cancer?
## < 0.2 ng/mL for RP
## < 2.0 ng/mL for RT