Introduction: Despite progress in the field of high-risk localized prostate cancer (HRPCa) treatments, high-risk patients treated with curative intent are at increased risk of experiencing PSA failure, metastatic progression and cancer-related death. The optimal treatment strategy for these patients remains a topic of debate. This review provides an overview of the current and investigational therapeutic options for HRPCa treatment. Areas covered: A PubMed search was performed for papers on the current evidence and perspectives on the multimodality treatment of HRPCa. We focus on both primary local treatment as well as systemic treatment options. Finally, relevant ongoing trials focusing on systemic treatments (including [neo]adjuvant treatments and chemotherapy) enrolling at least 50 patients were retrieved and listed, to highlight ongoing research and treatment optimization. Expert opinion: Disease progression in HRPCa patients is driven by local tumor extension and subclinical metastases. Therefore, the main treatment concept is a multimodal approach targeting the primary tumor with extended surgery or RT with long-term ADT and simultaneously targeting the micro-metastatic deposits. However, there is still room for further optimization. Upcoming clinical trials comparing surgery versus RT as local treatment option, numerous trials with (neo)adjuvant chemotherapy or androgen receptor signaling inhibitors will likely change the current treatment landscape. However, a multimodal treatment strategy will stay as the cornerstone in the treatment of HRPCa.
Expert review of anticancer therapy. 2020 Nov 22 [Epub ahead of print]
Lisa Moris, Gaëtan Devos, Thomas Van den Broeck, Daimantas Milonas, Maarten Albersen Maarten, Charlien Berghen, Gert De Meerleer, Devlies Wout, Wouter Everaerts, Thomas Gevaert, Hendrik Van Poppel, Frank Claessens, Steven Joniau
Department of Urology, University Hospitals Leuven , KU Leuven, Leuven, Belgium., Department of Radiation Oncology, University Hospitals Leuven , Leuven, Belgium., Department of Pathology, Catholic University Leuven , Belgium., Department of Cellular and Molecular Medicine, Laboratory of Molecular Endocrinology , KU Leuven, Leuven, Belgium.