[Recent advances in the management of localized high-risk prostate cancer: An update by the Prostate Cancer Committee of the French Association of Urology].

The risk of recurrence is increased in localized high-risk prostate cancer (PCa). The implementation of an appropriate diagnostic and therapeutic strategy is essential. The objective of this update by the Prostate Committee of the French Association of Urology was to report the most recent data in the management of localized high-risk PCa.

This update is based on the data available in the literature on localized high-risk PCa. A PubMed search and narrative review of the recent data were performed in March 2022.

Compared with conventional imaging, PET-PSMA is more effective for the diagnosis of lymph nodes and distant metastases. Two recent randomized clinical trials have failed to prove the oncologic benefit of extended pelvic lymph node dissection during radical prostatectomy (RP). Postoperatively, early salvage radiotherapy is the standard of care, with adjuvant radiotherapy becoming an option in case of unfavorable pathological criteria (ISUP 4-5, pT3±positive margins) in young patients. Although promising, perioperative systemic therapies (chemotherapy, second-generation hormonotherapy) cannot be recommended at this time when the patient is treated by RP. Regarding radiotherapy, prophylactic lymph node irradiation during prostatic irradiation was associated with improved biochemical and metastasis-free survival in a recent randomized trial but it is still controversial. Since the publication of the results of the STAMPEDE trial, the addition of abiraterone acetate to radiation-hormone therapy should be considered the new standard of care for patients with localized (very) high-risk PCa, according to the inclusion criteria of the study.

The most recent data of the literature regarding the management of high-risk localized PCa redefine the diagnostic performance of molecular imaging, the timing of postoperative radiotherapy, the oncologic benefit of pelvic lymph node treatment, and the intensification of systemic therapies.

Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2022 May 26 [Epub ahead of print]

M Baboudjian, J-B Beauval, E Barret, L Brureau, G Créhange, C Dariane, G Fiard, G Fromont, M Gauthé, R Mathieu, R Renard-Penna, G Roubaud, A Ruffion, P Sargos, M Rouprêt, G Ploussard, Prostate Cancer Committee of the Association française d’urologie (CC-AFU)

Department of Urology, AP-HM, North Academic Hospital, Marseille, France; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Espagne. Electronic address: ., Department of Urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France; IUCT-O, Toulouse, France., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail (Irset), UMR_S 1085, 97110 Pointe-à-Pitre, Guadeloupe., Department of Radiotherapy, Institut Curie, Paris, France., Department of Urology, Hôpital européen Georges-Pompidou, AP-HP, Paris University, U1151 Inserm-INEM, Necker, Paris, France., Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France., Department of Pathology, CHRU Tours, Tours, France., Department of Nuclear Medicine, Scintep, Institut Daniel Hollard, Grenoble, France., Department of Urology, CHU Rennes, Rennes, France., Sorbonne University, AP-HP, Radiology, Pitié-Salpetrière Hospital, 75013 Paris, France., Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France., Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Équipe 2, Centre d'Innovation en cancérologie de Lyon (EA 3738 CICLY), Faculté de médecine Lyon Sud, Université Lyon 1, Lyon, France., Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France., Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitié-Salpetrière Hospital, 75013 Paris, France., Department of Urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France; IUCT-O, Toulouse, France; Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.

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