High-risk prostate cancer: from definition to contemporary management |
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Authors: | Bastian Patrick J Boorjian Stephen A Bossi Alberto Briganti Alberto Heidenreich Axel Freedland Stephen J Montorsi Francesco Roach Mack Schröder Fritz van Poppel Hein Stief Christian G Stephenson Andrew J Zelefsky Michael J |
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Affiliation: | 1. Department of Urology, Klinikum der Universität München—Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany;2. Department of Urology, Mayo Clinic, Rochester, MN, USA;3. Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France;4. Department of Urology, Vita-Salute University San Raffaele, Milan, Italy;5. Department of Urology, Universitätsklinikum der RWTH Aachen, Aachen, Germany;6. Section of Surgery, Durham VA and Departments of Surgery (Urology) and Pathology, Duke Prostate Center, Duke University, Durham, NC, USA;g Department of Radiation Oncology, UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA;h Erasmus MC, University Medical Center, Rotterdam, The Netherlands;i Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium;j Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA;k Memorial Sloan-Kettering Cancer Center, New York, NY, USA |
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Abstract: | ContextHigh-risk prostate cancer (PCa) is a potentially lethal disease. It is clinically important to identify patients with high-risk PCa early on because they stand to benefit the most from curative therapy. Because of recent advances in PCa management, a multimodal approach may be advantageous.ObjectiveDefine high-risk PCa, and identify the best diagnostic and treatment patterns for patients with clinically localized and locally advanced disease. A critical analysis of published results following monomodal and/or multimodal therapy for high-risk PCa patients was also performed.Evidence acquisitionA review of the literature was performed using the Medline, Embase, Scopus, and Web of Science databases as well as the Cochrane Database of Systematic Reviews.Evidence synthesisHigh-risk PCa accounts for ≤15% of all new diagnoses. Compared with patients with low- and intermediate-risk PCa, patients with high-risk PCa are at increased risk of treatment failure. Unfortunately, no contemporary randomized controlled trials comparing different treatment modalities exist. Evaluation of the results published to date shows that no single treatment can be universally recommended. Most often, a multimodal approach is warranted to optimize patient outcomes.ConclusionsA significant minority of patients continue to present with high-risk PCa, which remains lethal in some cases. Outcomes following treatment of men with high-risk tumors have not substantially improved over time. However, not all high-risk patients are at the same risk of PCa progression and death. At present, a multimodal approach seems the best way to achieve acceptable outcomes for high-risk PCa patients. |
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Keywords: | Prostate cancer High-risk prostate cancer Radical prostatectomy Radiation therapy Adjuvant therapy Biomarker Androgen-deprivation therapy |
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