Treatment of Patients with Clinical T3 Prostate Cancer

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Abstract
Objective : To describe and evaluate treatment alternatives for patients with clinical T3 prostate cancer. Material and Methods : Literature review with main focus on recent studies in order to include the impact of prostate specific antigen (PSA). The possibility of using neoadjuvant/adjuvant hormonal therapy in combination with surgery or radiation was assessed. Results were related to life expectancy, tumour grade and serum PSA. Results : M and N-staging is mandatory before treatment with curative intent. Watchful waiting is an option for selected patients but early hormonal therapy seems to offer some survival advantages. Standard 65-70Gy external beam radiation is not sufficient for these patients with extracapsular disease but better results are obtained with dose-escalation (beyond 70Gy) and/or adjuvant hormonal therapy. Radical prostatectomy may be an option for patients with long life expectancy and "early" tumours, neoadjuvant hormonal withdrawal is of no proven value. Conclusions : Patients with a long life expectancy should not be denied treatment with curative intent solely based on the finding of extracapsular disease.