Adjuvant therapy for prostate cancer patients at high risk of recurrence following radical prostatectomy.
OBJECTIVE
To identify which patients with prostate cancer are at high risk for local or distant recurrence after radical prostatectomy.


METHODS
Review of data from several historical and contemporary series of patients undergoing radical prostatectomy.


RESULTS
Patients with high-grade disease (i.e., Gleason score > or = 8), positive margins, and seminal vesicle invasion have relatively high risks of biochemical and clinical failure if no adjuvant therapy is given. Use of radiation therapy may improve local control rates for a subset of these patients (i.e., those with positive margins) but appears to have little impact on the later development of metastatic disease or of prostate cancer death. Hormone therapy may delay the onset of failure for other patients with 'high-risk' disease but there are few data to support its widespread use.


CONCLUSIONS
Enhanced ability to predict which patients with high-risk prostate cancer will fail locally after radical prostatectomy is needed. Such patients should then be enrolled in a randomized study of postoperative adjuvant radiation therapy. Similarly, patients predicted to be at high risk for distant failure should be enrolled in trials evaluating conventional and 'novel' forms of hormonal therapy (i.e., potency sparing regimens) to determine whether such therapy delays the time to biochemical or clinical progression without compromising the patient's quality of life.
Andriole
G L
GL
Division of Urology, Washington University School of Medicine, St. Louis, Mo., USA.
D000726:Androgen Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D016032:Randomized Controlled Trials as Topic / Q000639:trends; D018570:Risk Assessment; D017211:Treatment Failure
D000726:Androgen Antagonists; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen