Korean J Urol.  2012 Dec;53(12):815-820. 10.4111/kju.2012.53.12.815.

Optimizing the Management of High-Risk, Localized Prostate Cancer

• Sundi D
• Jeong BC
• Lee SB
• Han M

• KMID: 1988724
• DOI: http://doi.org/10.4111/kju.2012.53.12.815

Abstract

Prostate cancer has a high prevalence and a rising incidence in many parts of the world. Although many screen-detected prostate cancers may be indolent, prostate cancer remains a major contributor to mortality in men. Therefore, the appropriate diagnosis and treatment of localized prostate cancer with lethal potential are of great importance. High-risk, localized prostate cancer has multiple definitions. Treatment options that should be individualized to each patient include observation, radical prostatectomy, external beam radiotherapy, brachytherapy, androgen deprivation, and combined modality treatment. Specific outcomes of radical prostatectomy and combined modality treatment for high-risk prostate cancer are reviewed. The rationale for extended pelvic lymphadenectomy at the time of surgery is discussed, as is the role for surgery in the setting of node-positive, high-risk disease. There is not yet a biomarker that accurately identifies lethal prostate cancer, but rigorous clinical studies have identified methods of optimizing oncologic outcomes in high-risk men.

Keyword

Prostate-specific antigen; Prostatectomy; Prostatic neoplasms; Radiotherapy

MeSH Terms

Brachytherapy
Humans
Incidence
Lymph Node Excision
Male
Prevalence
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Prostate-Specific Antigen

Reference

1. Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer. 2012. 07. 03. [Epub]. http://dx.doi.org/10.1002/ijc.27711.

2. Quinn M, Babb P. Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons. BJU Int. 2002. 90:162–173.

3. Draisma G, Etzioni R, Tsodikov A, Mariotto A, Wever E, Gulati R, et al. Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst. 2009. 101:374–383.

4. Oliver SE, May MT, Gunnell D. International trends in prostate-cancer mortality in the "PSA ERA". Int J Cancer. 2001. 92:893–898.

5. Song C, Kang T, Ro JY, Lee MS, Kim CS, Ahn H. Nomograms for the prediction of pathologic stage of clinically localized prostate cancer in Korean men. J Korean Med Sci. 2005. 20:262–266.

6. Song C, Ahn H, Lee MS, Park J, Kwon TG, Kim HJ, et al. Mass screening for prostate cancer in Korea: a population based study. J Urol. 2008. 180:1949–1952.

7. Byun SS, Lee S, Lee SE, Lee E, Seo SI, Lee HM, et al. Recent changes in the clinicopathologic features of Korean men with prostate cancer: a comparison with Western populations. Yonsei Med J. 2012. 53:543–549.

8. D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998. 280:969–974.

9. Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS, et al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol. 2007. 177:2106–2131.

10. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN Guidelines): neuroendocrine tumors. ver. 3. 2012 [internet]. c2012. cited 2012 Sep 10. Fort Wathington: NCCN;Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

11. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol. 2011. 59:61–71.

12. Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M, et al. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. 2012. 07. 26. [Epub]. http://dx.doi.org/10.1111/j.1464-410X.2012.11324.x.

13. Cooperberg MR, Freedland SJ, Pasta DJ, Elkin EP, Presti JC Jr, Amling CL, et al. Multiinstitutional validation of the UCSF cancer of the prostate risk assessment for prediction of recurrence after radical prostatectomy. Cancer. 2006. 107:2384–2391.

14. Han M, Partin AW, Zahurak M, Piantadosi S, Epstein JI, Walsh PC. Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol. 2003. 169:517–523.

15. Kattan MW, Vickers AJ, Yu C, Bianco FJ, Cronin AM, Eastham JA, et al. Preoperative and postoperative nomograms incorporating surgeon experience for clinically localized prostate cancer. Cancer. 2009. 115:1005–1010.

16. Zelefsky MJ, Kattan MW, Fearn P, Fearon BL, Stasi JP, Shippy AM, et al. Pretreatment nomogram predicting ten-year biochemical outcome of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for prostate cancer. Urology. 2007. 70:283–287.

17. Grossfeld GD, Latini DM, Lubeck DP, Mehta SS, Carroll PR. Predicting recurrence after radical prostatectomy for patients with high risk prostate cancer. J Urol. 2003. 169:157–163.

18. Pierorazio PM, Ross AE, Han M, Epstein JI, Partin AW, Schaeffer EM. Evolution of the clinical presentation of men undergoing radical prostatectomy for high-risk prostate cancer. BJU Int. 2012. 109:988–993.

19. Bill-Axelson A, Holmberg L, Ruutu M, Garmo H, Stark JR, Busch C, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2011. 364:1708–1717.

20. D'Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A, Kantoff PW. 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA. 2004. 292:821–827.

21. Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med. 1997. 337:295–300.

22. Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, et al. Outcomes of localized prostate cancer following conservative management. JAMA. 2009. 302:1202–1209.

23. Loeb S, Schaeffer EM, Trock BJ, Epstein JI, Humphreys EB, Walsh PC. What are the outcomes of radical prostatectomy for high-risk prostate cancer? Urology. 2010. 76:710–714.

24. Cooperberg MR, Cowan J, Broering JM, Carroll PR. High-risk prostate cancer in the United States, 1990-2007. World J Urol. 2008. 26:211–218.

25. Antonarakis ES, Feng Z, Trock BJ, Humphreys EB, Carducci MA, Partin AW, et al. The natural history of metastatic progression in men with prostate-specific antigen recurrence after radical prostatectomy: long-term follow-up. BJU Int. 2012. 109:32–39.

26. Pierorazio PM, Ross AE, Lin BM, Epstein JI, Han M, Walsh PC, et al. Preoperative characteristics of high-Gleason disease predictive of favourable pathological and clinical outcomes at radical prostatectomy. BJU Int. 2012. 110:1122–1128.

27. Zelefsky MJ, Eastham JA, Cronin AM, Fuks Z, Zhang Z, Yamada Y, et al. Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol. 2010. 28:1508–1513.

28. Cooperberg MR, Vickers AJ, Broering JM, Carroll PR. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010. 116:5226–5234.

29. Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988-2006. Eur Urol. 2011. 59:88–95.

30. Westover K, Chen MH, Moul J, Robertson C, Polascik T, Dosoretz D, et al. Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer. BJU Int. 2012. 110:1116–1121.

31. Heidenreich A, Ohlmann CH, Polyakov S. Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol. 2007. 52:29–37.

32. Lindberg C, Davidsson T, Gudjonsson S, Hilmarsson R, Liedberg F, Bratt O. Extended pelvic lymphadenectomy for prostate cancer: will the previously reported benefits be reproduced in hospitals with lower surgical volumes? Scand J Urol Nephrol. 2009. 43:437–441.

33. Briganti A, Suardi N, Capogrosso P, Passoni N, Freschi M, di Trapani E, et al. Lymphatic spread of nodal metastases in high-risk prostate cancer: The ascending pathway from the pelvis to the retroperitoneum. Prostate. 2012. 72:186–192.

34. Hyndman ME, Mullins JK, Pavlovich CP. Pelvic node dissection in prostate cancer: extended, limited, or not at all? Curr Opin Urol. 2010. 20:211–217.

35. Sagalovich D, Calaway A, Srivastava A, Sooriakumaran P, Tewari AK. Assessment of required nodal yield in a high risk cohort undergoing extended pelvic lymphadenectomy in robotic-assisted radical prostatectomy and its impact on functional outcomes. BJU Int. 2012. 07. 23. [Epub]. http://dx.doi.org/10.1111/j.1464-410X.2012.11351.x.

36. Bader P, Burkhard FC, Markwalder R, Studer UE. Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol. 2003. 169:849–854.

37. Allaf ME, Palapattu GS, Trock BJ, Carter HB, Walsh PC. Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol. 2004. 172(5 Pt 1):1840–1844.

38. Walsh PC, Worthington JF. Dr. Patrick Walsh's guide to surviving prostate cancer. 2012. 3rd ed. New York: Wellness Central.

39. Cadeddu JA, Partin AW, Epstein JI, Walsh PC. Stage D1 (T1-3, N1-3, M0) prostate cancer: a case-controlled comparison of conservative treatment versus radical prostatectomy. Urology. 1997. 50:251–255.

40. Steuber T, Budaus L, Walz J, Zorn KC, Schlomm T, Chun F, et al. Radical prostatectomy improves progression-free and cancer-specific survival in men with lymph node positive prostate cancer in the prostate-specific antigen era: a confirmatory study. BJU Int. 2011. 107:1755–1761.