Treatment of Patients with Clinical T3 Prostate Cancer

Author： Aus G. Adolfsson J. Selli C. Widmark A.

ISSN： 0036-5599

Source： Scandinavian Journal of Urology and Nephrology, Vol.36, Iss.1, 2002-01, pp. : 28-33

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Abstract

Objective: To describe and evaluate treatment alternatives for patients with clinical T3 prostate cancer.Material and 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.