Editorials

Photodynamic therapy for low risk prostate cancer

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j575 (Published 08 February 2017) Cite this as: BMJ 2017;356:j575
  1. Chad R Ritch, assistant professor,
  2. Sanoj Punnen, assistant professor
  1. Department of Urology, University of Miami Leonard M Miller School of Medicine, Miami, FL, USA
  1. Correspondence to: C R Ritch critch{at}miami.edu

No substitute for active surveillance yet

Prostate cancer is the second most common cancer in men. However, a substantial proportion of the cancers diagnosed annually are low risk: clinical stage ≤T2, prostate specific antigen (PSA) <10 ng/mL, and Gleason score 6 (3+3).1 2 3 Management options include surgery, radiotherapy, ablative therapy, and active surveillance. Active surveillance, which involves prostate biopsies and PSA tests at scheduled intervals, with intervention when indicated is the preferred choice for most men with low risk disease. Surgery and radiotherapy, though effective at eradicating the cancer, are considered radical treatments with associated sexual and urinary side effects. Ablative therapy (cryotherapy, high intensity focused ultrasound, electroporation, and laser guided photodynamic therapy) is considered less radical, particularly when used to ablate just the tumour (focal therapy), and possibly less harmful to sexual and urinary function.

There is undeniable evidence that the risk of death from low risk prostate cancer is, as the name suggests, low.4 5 6 Then why do we …

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