ABSTRACT

Aim:

As all cancer types, the definition of high risk prostate cancer (PCa) and the patients groups who get involved in this definition should be throughly determined. However, it is very difficult to say which treatment is suitable for the patients. In this review, surgical treatment and/or radiotherapy in high risk PCa is evaluated according to current literature.

New Findings:

Although increasing role of imaging modalities and Partin tables/nomograms for predicting the permanent pathology in recent years, 13-27% of permanent pathologies in clinically T3 PCa patients were determined as localized PCa. Even lymph node and systemic invasion is known to be high in high risk PCa, some publications are present to make us think that local control could be important. However, it is emphasized that better results could be obtained with aggressive multimodal treatments protocols in high risk PCa. The high-risk features (R1) in prostatectomy specimens define as indications of adjuvant radiotherapy (ART). In the studies, It is found that ART has higher 5 years biochemical recurrence-free survival and better local control regarding to salvage radiotherapy.

Conclusion:

Oncologic results of single treatments as only surgery or radiotherapy are not sufficient in high risk PCa and these patients take an advantage of multimodal therapy. In the future, it is expected that these patients may benefit much more from new algorithms that constitute local curative treatments combined with effective adjuvant treatments.