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Stage III Prostate Cancer Treatment

    Overview

    Stage III prostate cancer is defined by the American Joint Committee on Cancer's TNM classification system:[1]

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    • T3a–b, N0, M0, any prostate-specific antigen (PSA), any Gleason.

    Extraprostatic extension with microscopic bladder neck invasion (T4) is included with T3a.

    External-beam radiation therapy (EBRT), interstitial implantation of radioisotopes, and radical prostatectomy are used to treat stage III prostate cancer.[2] Prognosis is greatly affected by whether regional lymph nodes are evaluated and proven not to be involved.

    EBRT using a linear accelerator is the most common treatment for patients with stage III prostate cancer, and large series support its success in achieving local disease control and disease-free survival (DFS).[3,4] The results of radical prostatectomy in stage III patients are greatly inferior compared with results in patients with stage II cancer. Interstitial implantation of radioisotopes is technically difficult in large tumors.

    The patient's symptoms related to cancer, age, and coexisting medical illnesses should be taken into account before deciding on a therapeutic plan. In a series of 372 patients treated with radiation therapy and followed for 20 years, 47% eventually died of prostate cancer, but 44% died of intercurrent illnesses without evidence of prostate cancer.[4]

    Standard Treatment Options for Stage III Prostate Cancer

    Standard treatment options for stage III prostate cancer include the following:

    1. External-beam radiation therapy (EBRT) with or without hormonal therapy.
    2. Hormonal manipulations (orchiectomy or luteinizing hormone-releasing hormone [LH-RH] agonist).
    3. Radical prostatectomy with or without EBRT.
    4. Watchful waiting or active surveillance.

    External-beam radiation therapy (EBRT) with or without hormonal therapy

    EBRT alone [3,4,5,6,7] or hormonal therapy luteinizing hormone-releasing hormone (LH-RH) agonist or orchiectomy) in addition to EBRT should be considered.[8,9,10,11,12,13,14,15,16] Definitive radiation therapy should be delayed until 4 to 6 weeks after transurethral resection to reduce the incidence of stricture.[17]

    Hormonal therapy should be considered in conjunction with radiation therapy especially in men who do not have underlying moderate or severe comorbidities.[8,9] Several studies have investigated its utility in patients with locally advanced disease.

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