Treatment of patients with clinical T3 prostate cancer.
OBJECTIVE
To describe and evaluate treatment alternatives for patients with clinical T3 prostate cancer.


METHODS
Literature review with main focus on recent studies in order to include the impact of prostate specific antigen (PSA). The possibility of using neoadjuvant/adjuvant hormonal therapy in combination with surgery or radiation was assessed. Results were related to life expectancy, tumour grade and serum PSA.


RESULTS
M and N-staging is mandatory before treatment with curative intent. Watchful waiting is an option for selected patients but early hormonal therapy seems to offer some survival advantages. Standard 65-70Gy external beam radiation is not sufficient for these patients with extracapsular disease but better results are obtained with dose-escalation (beyond 70Gy) and/or adjuvant hormonal therapy. Radical prostatectomy may be an option for patients with long life expectancy and "early" tumours, neoadjuvant hormonal withdrawal is of no proven value.


CONCLUSIONS
Patients with a long life expectancy should not be denied treatment with curative intent solely based on the finding of extracapsular disease.
Aus
G
G
Department of Urology, Ryhov Hospital, Jönköping, Sweden. gunnar.aus@ryhov.ltjkpg.se
Adolfsson
J
J
Selli
C
C
Widmark
A
A
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D008017:Life Expectancy; D008297:Male; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*
D018931:Antineoplastic Agents, Hormonal