High-risk prostate cancer: From definition to contemporary management Journal Article
| Authors: | Bastian, P. J.; Boorjian, S. A.; Bossi, A.; Briganti, A.; Heidenreich, A.; Freedland, S. J.; Montorsi, F.; Roach, M. 3rd; Schroder, F.; Van Poppel, H.; Stief, C. G.; Stephenson, A. J.; Zelefsky, M. J. |
| Article Title: | High-risk prostate cancer: From definition to contemporary management |
| Abstract: | Context: High-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. Objective: Define 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 acquisition: A 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 synthesis: High-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. Conclusions: A 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. © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. |
| Keywords: | cancer survival; treatment outcome; survival rate; overall survival; review; intensity modulated radiation therapy; advanced cancer; cancer growth; cancer risk; multimodality cancer therapy; patient selection; adjuvant therapy; cancer adjuvant therapy; cancer radiotherapy; chemotherapy, adjuvant; neoadjuvant therapy; radiotherapy, adjuvant; follow up; lymph node metastasis; cancer diagnosis; lymph node dissection; pelvis lymph node; lymph node excision; evidence-based medicine; prostate specific antigen; metastasis; progression free survival; multiple cycle treatment; risk factors; risk factor; high risk patient; time factors; risk assessment; docetaxel; prostate cancer; prostatic neoplasms; gastrointestinal toxicity; systematic review; prostatectomy; disease progression; biomarker; androgen antagonists; predictive value of tests; brachytherapy; radical prostatectomy; intermethod comparison; medline; terminology as topic; radiation therapy; medical literature; external beam radiotherapy; antineoplastic agents, hormonal; cochrane library; urogenital tract disease; androgen deprivation therapy; disease specific survival; embase; androgen-deprivation therapy; clinical trial (topic); intermediate risk patient; proton therapy; estramustine; low risk patient; high-risk prostate cancer; biochemical recurrence free survival |
| Journal Title: | European Urology |
| Volume: | 61 |
| Issue: | 6 |
| ISSN: | 0302-2838 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2012-06-01 |
| Start Page: | 1096 |
| End Page: | 1106 |
| Language: | English |
| DOI: | 10.1016/j.eururo.2012.02.031 |
| PROVIDER: | scopus |
| PUBMED: | 22386839 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 4 June 2012" - "CODEN: EUURA" - "Source: Scopus" |
