Treatment of locally advanced prostatic cancer

Abstract

An exact staging of clinical T3 stadium is usually difficult because of the frequent over and under staging. The risk prognostic stratification is performed through nomograms and ANN (artificial neural networks). The options for treatment are: radical prostatectomy, external radiotherapy and interstitial implantation of radioisotopes, hormonal therapy by androgen blockade. Radical prostatectomy is considered in patients with T3 stage but extensive dissection of lymph nodes, dissection of neurovascular bundle (on tumor side), total removal of seminal vesicle and sometimes resection of bladder neck are obligatory. Postoperative radiotherapy is performed in patients with invasion of seminal vesicles and capsular penetration or with prostate specific antigen value over 0.1 ng/ml, one month after the surgical treatment. Definitive radiotherapy could be used as the best treatment option considering clinical stage, Gleason score, age, starting prostate specific antigen (PSA) value, concomitant diseases, life expectancy, quality of life, through multidisciplinary approach (combined with androgen deprivation). Hormonal therapy in intended for patients who are not eligible for surgical treatment or radiotherapy. Conclusion Management of locally advanced prostate cancer is still controversial and studies fbr better diagnosis and new treatment modalities are ongoing.

Significance of Neoadjuvant Hormonal Therapy in Radical Retropubic Prostatectomy: A Retrospective Single-Surgeon Study

“…There are several management options for early or intermediate stage PCa and management should be selected through informed consent with patients based on definite evidence 16,17. Though there are no evidence-based guidelines for the treatment of PCa of these stages that take into consideration differences in PCa characteristics among races,18 there are several PCa risk categorizations, such as Damico's classification, Kattan score or Partin tables,4,19,20 and therapeutic strategies should be selected according to these classifications.…”

Hormonal status in patients with advanced prostatic cancer on the therapy with androgen blockade

“…Ovo se postiže hirurškom ili farmakološ-kom kastracijom. Farmakološka blokada ostvaruje se primenom agonista ganodotropnog rilizing hormona (LH-RH) 5,6 i/ili antiandrogenima. Antiandrogeni su jedinjenja koja inhibiraju dejstvo androgena u ćelijama karcinoma prostate tako što blokiraju androgene receptore i sprečavaju vezivanje androgenih hormona za njih.…”

“…Antiandrogeni su jedinjenja koja inhibiraju dejstvo androgena u ćelijama karcinoma prostate tako što blokiraju androgene receptore i sprečavaju vezivanje androgenih hormona za njih. Pošto se hirurškom ili farmakološkom kastracijom eliminišu testikularni androgeni, dejstvo ekstratestikularnih androgena suprimira se davanjem različitih antiandrogena [5][6][7] . Spajanjem ova dva modaliteta terapije, postiže se maksimalna ili totalna androgena blokada (TAB) 8,9 .…”

Utilization of Gonadotropin-Releasing Hormone Agonists in the Treatment of Metastatic and Locally Advanced Prostate Cancer - Comparisons of Practices from Three European Countries

“…About 20-30% of prostate cancers do not respond to endocrine therapy, because the metabolism and activity of these cancer cells is independent of the activity of androgen hormons. Endocrine therapy can be divided into four groups: 5 androgen-producing organ ablation (surgical castration -orchiectomy), androgen synthesis inhibition (aminoglutetamide and ketoconazole), hypothalamic and pituitary suppression (gonadotropin-releasing hormone agonists (LHRH agonists) -pharmacological castration) and the inhibition of androgen activity in effector cells (anti-androgens, central and peripheral). Pharmacological blockade is achieved by the use of gonadotropin-releasing hormone (LHRH) agonists 6 and / or anti-androgens.…”