Active surveillance for low-to-intermediate-risk patients will certainly remain in the focus in the next years. Extended follow-up will be necessary to judge on disease-specific survival because absolute event numbers are comparably low. The long-term results of the completed studies will identify subgroups of patients who profit from ART, but for others, such as N+ with ≤2 involved nodes, new randomized trials are planned in order to achieve statistically significant results. For SRT, the correct timing is a challenge as PSA measurements become more and more sensitive. Side effects and quality of life are leading issues for the comparison of SRT and ART, so that altered doses and fractionation schemes (including hypofractionation) may be discussed in the future. Technically, arc therapy or IMRT and image-guided RT are likely to become standards within the next decade. The resulting reduction of toxicity may influence the decision about how and when to apply RT in post-RP PC patients.
Future Oncol. 2013;9(5):669-679. © 2013 Future Medicine Ltd.