High-Risk Prostate Cancer: A Very Challenging Disease in the Field of Uro-Oncology (2021, Editorial, Full Text)
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"Prostate cancer (PCa) is the most common cancer in males and affects 16% of men during their lifetime (1). Up to 40% of patients are classified as high-risk (PSA ≥ 20 ng/mL or Gleason score 8–10 or clinical stage ≥T3) (2). Despite improvement in patient selection and advances in treatment, disease recurrence remains substantial, affecting up to 50% of patients within 10 years and carrying a significant risk of progression and death (3,4).
Among non-curatively treated patients, 15 years mortality rate of a high-risk group is significant higher than intermediate and low risk groups (55% versus 20% versus 9%, respectively) (5). Guidelines on the management of high-risk localized prostate cancer suggest two main options: radical prostatectomy (RP) with extended pelvic lymphadenectomy (ePLND), alone or in combination with adjuvant treatments, and radiotherapy (RT) associated with androgen deprivation therapy (ADT) (6–8). Presently no prospective evidence exists comparing these two therapeutic options in this setting of patients.
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A good review of the current treatment landscape and studies regarding RP, RT, and adjuvant/neoadjuvant therapy.
Djin