UroToday - AUA 2008 - Society of Urologic Oncology Meeting - Prostate Cancer II – Management of the Primary Tumor in High Risk Nonmetastatic Prostate Cancer Argument for an Integrated Approach Starting with Radiation Therapy

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Saturday, 17 May 2008

ORLANDO, FL

(UroToday.com) - Dr. Sandler argued for an integrated approach to prostate

cancer beginning with radiotherapy (XRT). He described locally advanced CaP as

cT3b disease with high Gleason score and PSA. One can’t ask more of local

control and thus a multimodal treatment plan is needed. He was not in favor of

trying to cure these patients with a surgical approach. They would still need

XRT, he said. RTOG92-02, which was primarily in high risk patients showed a

benefit to adjuvant hormone deprivation for disease specific survival, but not

overall survival. He showed the flattening of the survival curves after 7 years

as suggesting some benefit.

He showed

the prospective EORTC 30001 trial of surgery in 40 men that perhaps supported

the use of surgery. However, it was not a large series and complications remain

an issue. In a large study of 15,000 patients, 9% had organ confined and 32%

had specimen confined disease. Many failed over a 10 year period.

Dr.

Sandler showed guidelines in the US

and Europe that state that surgery should only

be selectively applied to high risk CaP patients. If surgery is used, the

patients should recognize that additional XRT will likely be needed.

Presented

by Sandler, MD, at the Annual Meeting of the American Urological

Association (AUA) - May 17 - 22, 2008. Orange

County Convention

Center - Orlando,

Florida, USA.