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Prostate cancer is the most common cancer in men. Because these tumours are usually detected by early diagnosis, prostate cancer is often limited to the prostate when diagnosed. Withholding active treatment, with active surveillance or watchful waiting are full options for men with this diagnosis. In active surveillance, men receive a structured follow-up with repeated determinations of the prostate-specific antigen (PSA) and prostate biopsies, often supported by MRI. When the tumour develops, active treatment can still be initiated. With this approach, the 10-year survival rate is high and a significant proportion of men remain untreated. With watchful waiting no structural monitoring takes place; instead one waits until the prostate cancer becomes symptomatic. This mainly concerns bone pain due to metastasis and obstruction of the urethra due to local growth. Explanation about these options is essential and GPs can play an important role in this.

Cribriform and intraductal prostate cancer are both associated with an adverse outcome after radical prostatectomy. We included all patients with prostate cancer from the first screening round of the European Randomized Study of Screening for Prostate Cancer (ERSPC). All available slides were revised and scored for presence of cribriform and/or intraductal prostate cancer. Outcome measurements were biochemical recurrence and disease-specific survival. In total, 486 patients had Gleason score (GS) 6 (47%) and 545 GS ≥7 (53%). The disease-specific survival and biochemical-recurrence-free survival of CR/IDC−-GS3+4 patients did not differ significantly from those with GS 6, while patients with CR/IDC+-GS3+4-patients had a significant poorer outcome. Conclusion: The presence of cribriform and intraductal growth in prostate cancer, is a strong clinical prognostic marker with potential. The use of this variable in a clinical setting could contribute to reducing overtreatment of prostate cancer.

An innovative fusion of previously acquired magnetic resonance imaging (MRI) images with real-time transrectal ultrasound (US) may lead to improved prostate cancer detection, thus necessitating fewer biopsies. Suspicious lesions can be identified, localised - and possibly classified - via an MRI scan. Subsequently, a biopsy needle can be guided accurately into the suspicious area of the prostate in real-time under MRI/US-fusion guidance. The current systematic transrectal ultrasound-guided biopsy technique may fail to detect clinically relevant cancers, while biopsies are often taken of indolent non-significant tumours. This relative underdiagnosis and overdiagnosis could partly be overcome by first performing an MRI scan, followed by supplementary MRI/US-targeted transrectal prostate biopsy on indication. This could result in a more effective method for performing prostate biopsies, though caution is required until further investigation has shown that no relevant cancers are missed when using this biopsy technique.