Abstract
Traditionally, patients with high-risk localized prostate cancer have been an extremely challenging group to manage due to a significant likelihood of treatment failure and prostate cancer-specific mortality (PCSM). The results of multiple large, prospective, randomized trials have demonstrated that men with high-risk features who are treated in a multimodal fashion at the time of initial diagnosis have improved overall survival. Advances in local treatments such as dose-escalated radiotherapy in conjunction with androgen suppression and postprostatectomy adjuvant radiotherapy have also demonstrated benefits to this subset of patients. However, therapeutic enhancement with the addition of chemotherapy to the primary treatment regimen may help achieve optimal disease control.
Highlights
Prostate cancer is the most common noncutaneous malignancy and is the second leading cause of cancer-related mortality among men in the USA [1]
This study reports that men with Prostate-specific antigen (PSA) > 20 ng/mL and a Gleason score < 8 are at minimal risk for prostate cancer-specific mortality (PCSM) and may represent a specific subgroup of high-risk patients that should be considered for surgery [11]
A follow-up prospective phase III trial, RTOG 05-21, was designed to assess the efficacy of a less toxic adjuvant chemotherapy regimen when combined with Androgen Deprivation Therapy (ADT) and radiotherapy
Summary
Prostate cancer is the most common noncutaneous malignancy and is the second leading cause of cancer-related mortality among men in the USA [1]. In a multi-institutional study of 4133 prostate cancer patients, combining preoperative serum PSA levels with the Gleason score and clinical stage was able to more accurately predict capsular penetration, involvement of seminal vesicles and pelvic lymph nodes [3]. A retrospective study by Walz et al reported that the number of risk factors (T3 disease, Gleason ≥ 8, D’Amico high-risk group, PSA ≥ 20 ng/mL) present influences the 5-year biochemical recurrence risk in the postradical prostatectomy setting. The most current guidelines define high-risk localized prostate cancer as patients with clinical stage T3 disease, a Gleason score of 8–10 or a PSA level > 20 ng/mL (Table 3). This paper alluded to the increasing importance of adjuvant therapy and multimodal approaches in order to improve control of high-risk localized disease [20]
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