Current opinion in urology
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High-risk prostate cancer (PCa) harbours a risk of local, regional and systemic relapse requiring the combination of a loco-regional treatment such as external beam radiotherapy for controlling the pelvic-confined disease, combined with an androgen deprivation therapy (ADT) to potentiate irradiation and to destroy the infraclinical androgen-dependent disease outside the irradiated volume. ⋯ For locally advanced PCa, the combination needs a long-term ADT (≥2 years) with luteinizing hormone-releasing hormone agonists. For high-risk localized PCa, the combination requires a 6-month complete androgen blockade. Image-guided intensity-modulated radiotherapy has replaced conventional irradiation and allows a dose escalation, improving the local control without increasing the toxicity. A multidisciplinary approach will enable physicians to tailor the treatment policy and a close cooperation with general practitioners and specialists will be set up to prevent as much as possible the side-effects of ADT.
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Prostate cancer remains the commonest nondermatological cause of cancer in Western men and the second leading cause of cancer death in these men. While low and intermediate-risk prostate cancers make up the vast bulk of prostate cancer diagnoses, it is high-risk prostate cancer that is a much larger killer. Management paradigms for such disease are changing and thus we review the current state of play with the management of these cancers and what the future might hold. ⋯ The increasing use of radical extirpative surgery might negatively impact functional outcomes but are likely to prolong lives of high-risk prostate cancer sufferers, though more research from well conducted randomized controlled trials is needed to exactly define which patient subpopulations should receive which therapies, in which orders, and at what times.