Prostate Cancer: What Is Locally Advanced Disease And How Should It Be Treated?

UroToday.com - Dr. Michael Blute, Mayo Clinic moderated the session "Prostate Cancer: What is Locally Advanced Disease and How Should it be Treated?".

Dr. Kenneth Koeneman, University of Minnesota spoke about "What is Locally Advanced Disease". He presented the classic definitions of high-risk disease and the CAPSURE data that locally advanced CaP has decreased from 19% in 1988 to 4.4% in 1998. In reviewing 6 ongoing clinical trials for locally advanced disease, the definition of this varied. Many used a published nomogram to determine this (Stephenson, J Clin Oncol 2005). Treatment patterns varied for treatment of this stage disease.

Dr. Anthony Zeitman, Massachusetts General Hospital presented "Why do Hormones Work with XRT and not Surgery?". He pointed out that pre-treatment ADT decreases the prostate size and subsequently the amount of radiation delivered to the rectum and bladder. Failure rates for larger tumors treated with radiotherapy are greater. In addition, there is a synergistic biological effect via enhanced apoptosis by using ADT with radiotherapy. Oxygenation may be improved with ADT that may be of benefit. The addition of ADT also seems to decrease the effective dose of radiotherapy required to achieve adequate treatment. An update of the RTOG 92-02 trial demonstrated that 10-year cancer-specific survival improved from 80% to 87% with 2 additional years of ADT after radiotherapy. He stated that there was no clear benefit in low risk patients, but results from RTOG 94-08 are awaited.

Dr. Michael Blute, presented "Is There a Role for Surgery, Are There Advantages to Surgery?". At the Mayo Clinic, patients undergo a non-nerve sparing RP with adjuvant treatment. At 20 years, node positive RP patients had a 72% vs. 51% survival for adjuvant vs. no adjuvant ADT. Dr. Blute pointed out that complications in the wide-resection RP remained low. He presented previously published surgical diagrams of the wide-excision RP as employed at the Mayo Clinic.

Report from The Society of Urologic Oncology Winter Meeting - National Institutes of Health - December 1-2, 2006

Reviewed by UroToday.com Contributing Editor Christopher P. Evans, M.D.

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