pT3 Prostate Cancer: The Case for Salvage (as Opposed to Adjuvant) Radiation Therapy

The adequate timing of radiation therapy for patients with prostate cancer with stage pT3 positive surgical margins (PSMs) at radical prostatectomy (RP) has been a long-lasting debate between the proponents of adjuvant radiation therapy (ART) in which the treatment is given on the basis of pathologic findings, and those of salvage radiation therapy (SRT), in which the treatment is given at biochemical or clinical relapse. The arguments in favor of one or the other attitude were of limited strength because they relied on nonrandomized, retrospective studies based on heterogenous patient populations. The scene dramatically changed in 2005 when three adequately powered, randomized clinical trials How then can one be presumptuous enough to argue a case apparently closed on the basis of evidence-based medicine and to make a plea for e u r o p e a n u r o l o g y s u p p l e m e n t s 6 ( 2 0 0 7 ) 5 2 1 -5 2 4 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Article info Keywords: Adjuvant Prostate cancer Radiation therapy Treatment Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. Abstract Objectives: It is unclear as yet whether or not adjuvant treatment for radical prostatectomy achieves better oncologic results than early salvage treatment. Methods: Three recently published randomized clinical trials have shown that adjuvant radiation therapy (ART) for pT3 prostate cancer with or without positive surgical margins (PSMs) and seminal vesicle invasion (SVI) is associated with a 25-30% improvement in biochemical and clinical relapse-free survival; however, this was not translated into a significant improvement in metastatic-free and overall survival. Results: Recent studies have shown that salvage radiation therapy (SRT) given at very low levels of prostate-specific antigen (0.5-1 ng/ml) is probably as efficient as adjuvant radiation therapy given to everyone in terms of biochemical-free survival. Conclusions: A plea is made for a more selective and individualized use of radiation therapy in prostate cancer patients with pT3 disease

Key take home messages

Large variations in practice are seen in applying hormonal therapy for prostate cancer. In contrast to older luteinizing hormone releasing hormone formulations, Eligard seems to achieve and maintain testosterone levels similar to those obtained by surgical castration. Oncologic and functional outcomes are more dependent on the surgeon than on the choice of the surgical procedure. © 2006 Elsevier B.V. All rights reserved.SCOPUS: sh.jinfo:eu-repo/semantics/publishe

ETUDE COMPARATIVE DU TRAITEMENT DES CALCULS RENAUX MESURANT PLUS DE 2 CM OU CALICIELS INFERIEURS PAR NEPHROLITHOTOMIE PERCUTANEE ET PAR LITHOTRIPSIE EXTRA CORPORELLE

ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

European Urology Supplements: Introduction

This supplement reports the proceedings of two meetings on urologic cancer control. The first meeting "Optimising testosterone control" deals with improving hormonal therapy for prostate cancer. The second meeting "Urological cancer surgery" evaluates open and laparoscopic surgery for prostate and bladder cancer. © 2006 Elsevier B.V. All rights reserved.SCOPUS: re.jinfo:eu-repo/semantics/publishe