Management of locally advanced prostate cancer

Abstract

The management of all stages of prostate cancer is an increasingly complex process and involves a variety of available treatments and many disciplines. Despite prostate-specific antigen (PSA) testing, the presentation of prostate cancer at a locally advanced stage is common in the UK, accounting for one-third of all new cases. There is no universally accepted definition of locally advanced prostate cancer; the term is loosely used to encompass a spectrum of disease profiles that show high-risk features. Men with high-risk prostate cancer generally have a significant risk of disease progression and cancer-related death if left untreated. High-risk patients, including those with locally advanced disease, present two specific challenges. There is a need for local control as well as a need to treat any microscopic metastases likely to be present but undetectable until disease progression. The optimal treatment approach will therefore often necessitate multiple modalities. The exact combinations, timing and intensity of treatment continue to be strongly debated. Management decisions should be made after all treatments have been discussed by a multidisciplinary team (including urologists, oncologists, radiologists, pathologists and nurse specialists) and after the balance of benefits and side effects of each therapy modality has been considered by the patient with regard to his own individual circumstances. This article reviews the current therapy options.

Perioperative complications of radical retropubic prostatectomy in patients with locally advanced prostate cancer: a comparison with clinically localized prostate cancer

“…Although a large number of studies 19,20 have focused on locally advanced PCa, the definition of this type of PCa remains ambiguous. Defining this term has been difficult for urologists and oncologists in the United Kingdom, who have not been able to reach a consensus.…”

The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score

“…For clinically localized organ-confined disease, radical prostatectomy has been established as the standard treatment, providing a 10-year progression-free probability in approximately 90% of men, 14 whereas for patients with more advanced disease with the presence of ECE or SVI, surgery may carry a substantial risk of positive surgical margins, subsequently compromising cancer control. In addition, invasion of seminal vesicles markedly reduces long-term survival in patients undergoing radical prostatectomy.…”

Impact of cancer service centralisation on the radical treatment of men with high‐risk and locally advanced prostate cancer: A national cross‐sectional analysis in England

“…Approximately one third of all men with a new diagnosis of prostate cancer in England have locally advanced disease . These men have a high risk of disease progression and cancer‐related mortality, highlighting the importance of radical treatment in this group . Contemporary data from the National Prostate Cancer Audit (NPCA) suggest that 27% of men with high‐risk or locally advanced prostate cancer do not receive radical treatment with surgery or radiotherapy .…”