Management of high-risk localized prostate cancer: the integration of local and systemic therapy approaches.
Using a combination of PSA, Gleason score, and clinical stage, it is possible to identify a group of patients with prostate cancer who have a high risk of relapse following initial treatment (e.g., radiotherapy or radical prostatectomy). For these patients, multi-modal therapy may result in improved outcomes. We reviewed published literature to identify methods to identify high-risk patients as well as options for adjuvant or neoadjuvant therapy to reduce risk of disease recurrence. At the present time, the most promising adjuvant therapy is hormonal therapy following radiotherapy for locally advanced disease (T3-T4, or N1). In phase III trials in these patients, survival is improved. For all other applications, including adjuvant and neoadjuvant hormonal therapy, chemotherapy, or radiotherapy, the benefits are unclear. Perhaps most promising at this time, and the subject of a current phase III trial, is the utility of adjuvant chemotherapy in high-risk patients. It will be through the conduct of phase III trials that the benefits of multi-modal therapy will be evaluated. Patients with high-risk prostate cancer undergoing radiotherapy or surgery should be offered participation in these clinical trials.
Syed
Samira
S
Institute for Drug Development, Cancer Therapy and Research Center, University of Texas Health Sciences Center, San Antonio, TX, USA.
Petrylak
Daniel P
DP
Thompson
Ian M
IM
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000728:Androgens; D000818:Animals; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D020360:Neoadjuvant Therapy; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy / Q000601:surgery; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D051381:Rats; D012306:Risk; D016896:Treatment Outcome
D000728:Androgens; D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal