[The treatment of locally advanced (T3) prostatic carcinoma using radical prostatectomy or radiotherapy. A review].
In the Netherlands 16% of all newly diagnosed prostatic carcinomas are already locally advanced (TNM-system: T3), which means that the tumor spreads beyond the prostatic capsule, or grows into the seminal vesicles. The pre-operative clinical staging is not very reliable when local tumor extension is concerned: the sensitivity for detecting extracapsular extension is 67% for digital rectal examination and 58% for transrectal ultrasonography of the prostate. In 50% of clinically locally confined tumors spread outside the prostate is found; and in 18% of the T3 tumors the tumor is confined to the prostate. In most clinics patients with locally advanced tumors are not considered to be candidates for radical prostatectomy, because the margins are small, due to anatomical factors. Progression and survival reported in the research literature for patients treated by radical prostatectomy for T3 prostate cancer are, however, at least equal to those treated with radiotherapy, which is considered the standard treatment for this stage. The average 10-year percentages for progression and survival of T3 prostate cancer patients treated by radical prostatectomy (or radiotherapy) are: clinical progression: 40% (radiotherapy: 61%); local recurrence 18% (35%); biochemical progression: 60% (93%); survival: 63% (39%); and prostate cancer specific survival: 78% (44%). These success-rates can not be compared directly, because of differences in physical condition and staging between the groups, which favor the radical prostatectomy group. There is, however, a subgroup of patients with undifferentiated carcinoma which shows high progression rates following radical prostatectomy; these patients need adjuvant hormonal treatment, or should be given a different therapy. The role of adjuvant radiotherapy following radical prostatectomy is still a matter of debate, as is the administration of neoadjuvant hormonal therapy. For the moment these therapies should only be given in clinical trials.
van den Ouden
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Ijsselland Ziekenhuis, Capelle a/d Ijssel.
Schröder
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FH
D000368:Aged; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant
De behandeling van lokaal uitgebreid (T3) prostaatcarcinoom met radicale prostatectomie of radiotherapie. Een overzicht.