What is the optimal management of high risk, clinically localized prostate cancer?

摘要: Abstract Objectives To summarize the presentations and debate regarding optimal treatment of localized high-risk prostate cancer as presented at 2009 Spring Meeting Society Urologic Oncology. Materials methods The was centered on arguing for radical prostatectomy (RP) or radiotherapy this condition. meeting are summarized by their respective presenters herein. Results Dr. James Eastham presents varied definitions “high-risk” strongly influencing which patients end up in cohort. Based upon this, between 3% 38% with features could be defined “high-risk”. Despite that, these men do not have a uniformly poor prognosis after RP, attention to surgical principles outlined improve outcomes. Disease-specific survival 12 years is excellent one-half may need adjuvant salvage therapies, depending specific disease characteristics. Adjuvant radiotherapies outcomes part sequential approach treating patients. Anthony Zietman gold-standard based large, randomized clinical trials intermediate- Compared androgen deprivation alone, addition provided 12% cancer-specific advantage 10% overall advantage. Dose escalation seems confer further improvements control without significant toxicities, more data forthcoming. Conclusions There no comparing RP any risk category. In patients, both approaches potential benefits cumulative toxicities that must matched characteristics patient expectations selecting course.