Clinical detection of T3 (extracapsular extension or seminal vesicle invasion) is rare, and is often difficult to detect. The vast majority of patients, even those who are otherwise high risk, are T1c or T2a. That’s why, when it is detected — either via biopsy, MRI or other advanced imaging — it must be taken very seriously. I believe that everyone diagnosed with cT3 should be referred to a radiation oncologist for consultation. The patient may choose surgery anyway, but the option of radiation should be given to him, along with a clear understanding of the risks and benefits attached to each option. In my experience with patients, their urologist often presents surgery plus salvage radiation as an equal alternative to primary radiation. It is not.
Similarly, I believe that patients diagnosed at
pathology with pT3 should be referred to a radiation oncologist for consultation. I stress consultation — not necessarily treatment. Many factors have to be considered to make a good decision about
whether early salvage treatment is warranted, but the patient should be apprised of the risks and benefits, and monitored closely.
I am very troubled by the trends cited in these two studies.
Declining use of RT in treating clinical stage T3 patients and those with adverse pathology after surgery- Allen