The risk classification for localized prostate cancer is based on the groups "low", "intermediate", and "high-risk" prostate cancer. Following this established risk group definition, locally advanced prostate cancer (cT3/4N0M0) has to be classified as "high-risk" prostate cancer. Radical prostatectomy or high-dose radiotherapy, which is combined with androgen deprivation, are the only curative standard treatments for locally advanced prostate cancer. Particularly adequate radiation doses, modern radiotherapy techniques like IMRT/IGRT, as well as long-term androgen suppression are essential for an optimal treatment outcome. In combination with definitive radiotherapy, androgen deprivation therapy should be started neoadjuvant/simultaneous to radiotherapy and is recommended to be continued after radiotherapy. Previous data suggest that 2‑year long-term androgen deprivation in this setting may not be inferior to 3‑year long-term androgen deprivation in high-risk patients. An additional radiation therapy of the lymphatic pathways in men with cN0 locally advanced/high-risk prostate cancer is still a matter of research. Ongoing trials may define selected subgroups with a suggested benefit at its best.
Der Urologe. Ausg. A. 2017 Oct 05 [Epub ahead of print]
N-S Schmidt-Hegemann, M Li, C Eze, C Belka, U Ganswindt
Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Klinikum der Universität München - LMU, Marchioninistr. 15, 81377, München, Deutschland. ., Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Klinikum der Universität München - LMU, Marchioninistr. 15, 81377, München, Deutschland.