O Rouvière and Dr. I.G. The stratification into "EAU Low-Risk" or "EAU High-Risk" BCR has recently been validated in a European cohort [Imaging is only of value if it leads to a treatment change and therefore to a better outcome. Metastases remained quite rare (6%), but more frequent than seen with AS protocols probably driven by differences in intensity of monitoring and patient selection. Several small RCTs have been conducted, however pooling analyses is hampered by variation in the definitions of incontinence, and surgical approach, such as open vs. robotic and intraperitoneal vs. extraperitoneal. Usually, LNs with a short axis > 8 mm in the pelvis and > 10 mm outside the pelvis are considered malignant. pT2/pT3 with positive surgical margins and GS 8-10) post-RP (Table 6.2.5.1). Using mpMRI and PSA changes as the sole triggers for re-biopsy would have detected only 14/20 (70%) of progressions and resulted in 15 additional biopsy procedures which failed to show pathological progression [Men may remain on AS whilst they continue to consent, have a life expectancy of > 10 years and the disease remains indolent.
(p = 0.1). This was complemented with pelvic floor muscle therapy. With a median follow-up of 94 months, MFS did not differ significantly when comparing 243 patients who had ART and 267 patients who had SRT at a PSA < 0.5 ng/mL (92% vs. 91%, p = 0.9) or OS (89% vs. 92%, p = 0.9). and should be treated for existing conditions, such as diabetes, hyperlipidaemia, and/or hypertension [After the initiation of ADT, it is recommended that patients are followed at 3 to 6 month intervals.
As a result of the complex information to be provided for each RP specimen, the use of synoptic(-like) or checklist reporting is recommended (Table 5.2.7.2). It is considered to be mediated through two main overlapping mechanisms: androgen-receptor (AR)-independent and AR-dependent mechanisms (see Section 6.5 - Castrate-resistant PCa). = not reported; RP = radical prostatectomy.The ProtecT trial randomised 1,643 patients, three-ways, between active treatment (RP or EBRT) and AM [The key finding is that AM is as effective as active treatment at 10 years, at a cost of increased progression and double the metastatic risk.
Predictive factors for poor outcomes were; CRPC, distant metastases, CSS, OS, short PSA-DT, high ISUP grade, high PSA, increased age and comorbidities. In CRPC imaging must be individualised with the aim of maintaining the patient's QoL.Testosterone monitoring should be considered part of clinical practice in men on LHRH therapy. The authors compared the oncological outcomes of the two salvage treatment options after mean follow-up periods of 7.8 (SRP group) and 5.5 years (SCAP group). as neoadjuvant(p = 0.044) (p = 0.0061) in subset with ISUP grade 4-5Significant benefit at 10 yr. for combined treatment (HR: 0.60, 95% CI: 0.45-0.80,Goserelin plus flutamide 3 or 6 mo. The risk of having positive LNs in intermediate-risk PCa is between 3.7-20.1% [Patients suitable for ADT can be given combined IMRT with short-term ADT (4-6 months) [Low-dose rate brachytherapy can be offered to highly selected patients (ISUP grade 2 with A prospective study on focal therapy using HIFU on patients with localised intermediate-risk disease was recently published [Data regarding the use of ADT monotherapy for intermediate-risk disease have been inferred indirectly from EORTC 30891 [Offer AS to highly selected patients (< 10% pattern 4) accepting the potential increased risk of further metastases.Offer RP to patients with intermediate-risk disease and a life expectancy of > 10 years.Offer nerve-sparing surgery to patients with a low risk of extracapsular disease.Perform an ePLND in intermediate-risk disease if the estimated risk for positive lymph nodes exceeds 5%.Offer low-dose rate brachytherapy to selected patients (see Section 6.2.3.2.3); patients without a previous transurethral resection of the prostate, with a good International Prostatic Symptom Score and a prostate volume < 50 mL.For external-beam radiation therapy (EBRT), use a total dose of 76-78 Gy or moderate hypofractionation (60 Gy/20 fx in 4 weeks or 70 Gy/28 fx in 6 weeks), in combination with short-term neoadjuvant plus concomitant androgen deprivation therapy (ADT) (4 to 6 months).In patients not willing to undergo ADT, use an escalated dose of EBRT (76-80 Gy) or a combination with brachytherapy.Only offer whole-gland ablative therapy (such as cryotherapy, high-intensity focused ultrasound, etc.)
It should be at least 66 Gy to the prostatic fossa (plus/minus the base of the seminal vesicles, depending on the pathological stage after RP) [Salvage RT is also associated with toxicity. Older age and worse baseline health status have been associated with a smaller benefit in PCa-specific mortality (PCSM) and life expectancy of surgery vs. active surveillance (AS) [Older men with a high incidence of PCa may be under-treated despite the high overall mortality rates [Life expectancy tables for European men are available at: Figure 5.4.1: Predicted Median Life Expectancy by Age and Gait Speed for males* *Figure reproduced with permission of the publisher, from Studenski S, The International SIOG PCa Working Group recommends that treatment for senior adults should be based on a systematic evaluation of health status using the G8 (Geriatric 8) screening tool (Table 5.4.1) [Comorbidity is a major predictor of non-cancer-specific death in localised PCa treated with RP and is more important than age [Malnutrition can be estimated from body weight during the previous 3 months (good nutritional status < 5% weight loss; risk of malnutrition: 5-10% weight loss; severe malnutrition: > 10% weight loss) [Cognitive impairment can be measured using mini-COG (Measures for overall physical functioning include: Karnofsky score and ECOG scores [Individual life expectancy, health status, and comorbidity, not only age, should be central in clinical decisions on screening, diagnostics, and treatment for PCa. This information is publicly accessible through the European Association of Urology website: This guidelines document was developed with the financial support of the European Association of Urology.
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