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Treatment strategies for high-risk locally advanced prostate cancer

Nature Reviews Urology volume 7, pages 31–38 (2010)Cite this article

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Abstract

High-risk prostate cancer can be defined by the assessment of pretreatment prognostic factors such as clinical stage, Gleason score, and PSA level. High-risk features include PSA >20 ng/ml, Gleason score 8–10, and stage T3 tumors. Patients with adverse prognostic factors have historically fared poorly with monotherapeutic approaches. Multimodal treatment utilizing combined androgen suppression and radiotherapy has improved survival rates for patients with high-risk prostate cancer. In addition, multiple randomized trials in patients treated with primary radical prostatectomy have demonstrated improved outcomes with the addition of adjuvant radiotherapy. Improved radiotherapy techniques that allow for dose escalation, and new systemic therapy approaches such as adjuvant chemotherapy, present promising future therapeutic alternatives for patients with high-risk prostate cancer.

Key Points

  • Risk stratification using prognostic factors such as clinical stage, Gleason score, and PSA level is essential for determining the appropriate treatment for patients with prostate cancer

  • High-risk patients include those with Gleason score 8–10, PSA >20 ng/ml, and clinical stage T3 disease

  • The combination of radiotherapy and long-term androgen suppression improves disease control and survival, compared with either treatment alone, for patients with high-risk disease

  • Adjuvant radiotherapy following radical prostatectomy improves disease control and survival for patients with stage pT3 disease

  • Improved local treatments, such as dose-escalated radiotherapy, adjuvant radiotherapy following prostatectomy, and novel systemic treatments such as adjuvant chemotherapy have the potential to improve disease control in the future

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Acknowledgements

The authors would like to thank Heidi Mortensen, Medical Librarian, for her great help in assembling the references. Charles P. Vega, University of California, Irvine, CA is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Radiation Oncology Centers, Radiological Associates of Sacramento, 1500 Expo Parkway, Sacramento, 95815, CA, USA

    Seth A. Rosenthal

  2. Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, 90048, CA, USA

    Howard M. Sandler

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Correspondence to Seth A. Rosenthal.

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Howard M. Sandler declares he has acted as a consultant for Sanofi-Aventis. S. A. Rosenthal, the Journal Editor S. Farley and the CME questions author C. P. Vega declare no competing interests.

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Rosenthal, S., Sandler, H. Treatment strategies for high-risk locally advanced prostate cancer. Nat Rev Urol 7, 31–38 (2010). https://doi.org/10.1038/nrurol.2009.237

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