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The Management of Localized or Locally Advanced Prostate Cancer

  • Therapy in Practice
  • Published:
American Journal of Cancer

Abstract

Screening, early detection, and effective treatment of patients with prostate cancer have led to a stage shift with an increased proportion of organ-confined and, thus, curable tumors diagnosed. Some studies suggest a decrease in mortality of patients with prostate cancer. At present, 10-year disease-specific survival rates of more than 90% are observed after radical prostatectomy. Nevertheless, there are ongoing controversies over screening and management. Radical prostatectomy, external-beam radiotherapy, interstitial brachytherapy, and ‘watchful waiting’ are widely accepted treatment options. With growing surgical experience, especially in large centres, there is a low perioperative morbidity and mortality associated with radical prostatectomy, even in elderly patients. An experienced surgeon may be able to preserve urinary continence in more than 90% of patients. With the preservation of the neurovascular bundles and modern supportive care, sexual potency and activity may recover in the majority of patients treated in centers of excellence. No other treatment yields better tumor-control rates than radical prostatectomy; however, there has previously been a lack of prospective randomized trials. In cases of high-grade, localized prostate cancers, there are some arguments for the superiority of radical prostatectomy. It remains to be seen whether new, high-dose conformal radiotherapy may compete in this setting.

In elderly patients and those with significant comorbidity, low-volume-low-grade or advanced-disease, conservative management may be considered. Androgen withdrawal may be used as a primary, neoadjuvant, or adjuvant therapy or as treatment at relapse. Data supporting improvement in survival through the use of adjuvant hormonal treatment are derived mainly from studies of external-beam radiotherapy with locally advanced (and most likely micrometastatic) tumors.

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Acknowledgements

Professor Wirth is principal investigator of the ‘Bicalutamide Early Prostate Cancer Program’ which is supported by AstraZeneca.

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  1. Department of Urology, Carl Gustav Carus University Hospital, Technical University of Dresden, Fetscherstrasse 74, Dresden, Germany

    Manfred P. Wirth & Michael Froehner

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Correspondence to Manfred P. Wirth.

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Wirth, M.P., Froehner, M. The Management of Localized or Locally Advanced Prostate Cancer. Am J Cancer 1, 387–396 (2002). https://doi.org/10.2165/00024669-200201060-00002

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