Gunnar Aus

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.

Prostate cancer has its most frequent location in the posterior-lateral part of the gland. The aim of this study was to evaluate the cancer detection rate of six systemic prostate biopsies with mid lobar biopsies taken far laterally in the prostate. A total of 692 patients (aged 50--66 years) enrolled in a screening study underwent prostate biopsies because of an elevated serum prostate-specific antigen (PSA; > or =3 ng/ml) level. The outcome of the biopsies was related to findings at digital rectal examination (DRE) and transrectal ultrasound (TRUS) and to the location within the prostate. Prostate cancer was detected in 164 patients. DRE and TRUS were suspicious of malignancy in 66 cases (40%) and 84 cases (51%), respectively. The two biopsies taken far laterally midlobar in the prostate detected as many as 83% of the cancers and when combined with two apical biopsies, 96% of all cancers were detected. At PSA screening in this age-group, only 57% of the prostate cancers detectable by sextant biopsies were palpable or visible at TRUS. Most of the cancers (96%) were detectable by only four systematic, carefully directed biopsies. In men with normal DRE, the two lateral midlobar biopsies should be taken first during the biopsy procedure.

Objectives: To develop clinical guidelines for the management of patients with prostate cancer. Methods: Guidelines were compiled by a working panel based on current literature following a literature review using MEDLINE. Already published structured analysis from national and international guidelines was used, and panel consensus was employed when literature evidence was absent or of poor quality. Results: The full text of the guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article summarizes the main conclusions from the guidelines concerning the diagnosis and staging, treatment and follow–up of patients with prostate cancer. The diagnosis of prostate cancer should be based on histopathological or cytological examinations. N– and M–staging may be omitted in selected patients with a low serum prostate–specific antigen due to low risk of metastasis. Active treatment is warranted in most stages of prostate cancer but active monitoring is recommended for elderly patients with early stage tumours and is still optional in some other situations. Follow–up is based on a disease–specific history, serum–prostate–specific antigen supplemented by a digital rectal examination. Routine imaging is not necessary in asymptomatic patients. Conclusions: Prostate cancer is one of the most common malignancies in men. These guidelines have been drawn up to provide support in the management of this large group of patients.

The incidence of prostate cancer is increasing and, due to the use of PSA, more and more patients are diagnosed with localized disease. These patients may be offered treatment with the intent to cure. Traditionally, this has been either by radical prostatectomy or some form of radiation therapy. This article describes the minimally invasive method with permanent seed implantation. The procedure, indications, contraindications, side effects and results from the literature 28 patients have been treated so far with acceptable proximate side effects and reductions in serum-PSA as expected.