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CANCER & TREATMENTS SUPPORT & SURVIVORSHIP PREVENTION & RISK ASSESSMENT CLINICAL TRIALS & RESEARCH LIVING WITH CANCER | |
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Home > Cancer and Treatments > Prostate Cancer > Prostate Cancer Information > Prostate Cancer Education > Treatment Locally advanced diseaseThe treatment of patients with locally advanced prostate cancer (Stage T3 or T4) is radiation therapy with or without HDR interstitial therapy, androgen ablation plus external radiation, or radical prostatectomy (radical prostatectomy is a surgical procedure which removes the entire prostate gland, as well as some surrounding tissue), with or without androgen deprivation. (Androgen is male hormone; the most common of which is testosterone. It has been shown there is a connection between androgen and the production of some forms of prostate cancer cells).In this section:
External Beam Radiation Treatment (EBRT) with or without High Dose Radiation (HDR)interstitial therapyFor patients with locally extensive prostate cancer (Stage T3 - T6) the risk of cancer recurrence is high. This has prompted investigations into alternative means to intensify therapy.One strategy has been to deliver large fractions of radiotherapy using HDR interstitial techniques in combination with external-beam radiation treatment. The large interstitial fractions deliver a high dose to the prostate but spare normal tissues, due to the rapid dose fall-off outside of the implanted volume. Early experience with this strategy is encouraging; but long-term data on outcome, particularly in patients with locally extensive disease, are still being compiled. Patients with locally advanced prostate cancer probably are not good candidates for permanent prostate implants. Patients with stage T3-T4 tumors are at high risk of gross extra-prostatic involvement and this localized therapy may not offer adequate coverage of extra-prostatic disease.
Androgen ablation + external radiation therapyRecently, two potential benefits of the use of transient androgen ablation prior to external radiation have been identified. First, there may be some synergy between the apoptotic response induced by androgen deprivation and radiotherapy that may increase local control.Second, androgen deprivation results in an average 20% decrease in prostate volume. This volume reduction not only may reduce the number of target cells, and thereby improve tumor control, but also may shrink the prostate and, thus, diminish the volume of rectum and bladder irradiated during conformal therapy. Complete androgen blockade can be achieved with the luteinizing hormone-releasing hormone (LHRH), (Lupron) or Zoladex plus flutamide (Eulexin), Casodex, or nilutamide(such as Anadron or Nilandron). In addition, since metastases outside the prostate are the first manifestation of disease recurrence in many patients with prostate cancer, the use of early androgen deprivation may possibly delay, or even prevent, the development of metastatic disease. Whether the combination of androgen ablation and radiation therapy affords a survival advantage in patients with locally advanced disease has not been definitively established. However, the results of recent investigations suggest that the combination may, in fact, have a survival benefit.
Radical prostatectomy with or without adjuvant therapyRadical prostatectomy is a surgical procedure which removes the entire prostate gland, as well as some surrounding tissue. It can be performed by creating a lower mid-line incision through the pubic area. This method allows for pelvic lymph node dissection. Some urologists prefer the perineal approach, which removes the prostate gland through an incision between the anus and the scrotum. The perineal approach requires a separate incision if lymph node removal is desired.This is a reasonable option for patients with locally advanced prostate cancer. Stage T3 disease can be successfully treated with low morbidity and significant reductions in risk of local recurrence, with clinical over-staging. Well- and moderately differentiated cancers have cancer-specific survival rates of 30% to 76% at 10 years, comparable with that of other treatment outcomes. However, the risk of cancer recurrence after surgery for Stage T3-T4 cancer is substantial, and an adjuvant or secondary/salvage treatment will likely be required.
Treatment of node-positive diseaseRecent data from several US centers have reported a survival benefit in men who undergo radical prostatectomy despite the presence of micro-metastases to regional pelvic lymphnodes. These men tend to do better and survive longer when started on early hormonal therapy, either with orchiectomy or an LHRH-agonist.
Radiation therapyWhether any local treatment adds to overall survival in patients with known node involvement is debatable. This matter deserves further study. However, the addition of radiotherapy may be indicated in many situations, especially in young men.
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