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<p>Locally advanced prostate cancer (PC) is defined as stage T3 or T4 disease and thus has a&#xa0;high-risk profile according to the D’Amico, European Association of Urology (EAU), and National Comprehensive Cancer Network (NCCN) risk classifications. If life expectancy is sufficient, curative therapy is indicated with the goal of lasting tumor control, prevention of distant metastases, and improved overall survival. All international guidelines recommend the combination of radiotherapy (RT) and androgen deprivation therapy (ADT). Radical prostatectomy with extended lymphadenectomy alone has not been proven to be superior to definitive RT plus ADT in this setting. Approximately 50% of patients require additional treatments (locoregional RT ± ADT) after surgery. Therefore, individualized patient counseling, taking into account patient preferences, comorbidities, age, and functional status, plays a&#xa0;key role. With the additional risk factors of prostate-specific antigen (PSA) level and Gleason score/grade according to the International Society of Urological Pathology (ISUP), the group of T3/4&#xa0;patients represents a&#xa0;heterogenous cohort, who can be assigned to high- or very-high-risk profiles. A&#xa0;sufficiently high RT dose to the prostate and concomitant long-term ADT are crucial to the success of oncological treatment. High-precision techniques such as intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) enable higher RT doses without a&#xa0;significant increase in gastrointestinal (GI) or genitourinary (GU) side effects and are now considered standard. Furthermore, optimal imaging for initial staging in terms of multiparametric MRI (mpMRI) and prostate-specific membrane antigen-based positron-emission tomography/CT (PSMA-PET/CT) is particularly important, as this can significantly influence the treatment strategy.</p>

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Lokal fortgeschrittenes Prostatakarzinom – radioonkologische Aspekte

  • 期刊论文

  • 发表日期：

    2025年8月4日

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  • Ute Ganswindt,
  • Johannes Lanbach,
  • Samuel Moritz Vorbach

摘要

Locally advanced prostate cancer (PC) is defined as stage T3 or T4 disease and thus has a high-risk profile according to the D’Amico, European Association of Urology (EAU), and National Comprehensive Cancer Network (NCCN) risk classifications. If life expectancy is sufficient, curative therapy is indicated with the goal of lasting tumor control, prevention of distant metastases, and improved overall survival. All international guidelines recommend the combination of radiotherapy (RT) and androgen deprivation therapy (ADT). Radical prostatectomy with extended lymphadenectomy alone has not been proven to be superior to definitive RT plus ADT in this setting. Approximately 50% of patients require additional treatments (locoregional RT ± ADT) after surgery. Therefore, individualized patient counseling, taking into account patient preferences, comorbidities, age, and functional status, plays a key role. With the additional risk factors of prostate-specific antigen (PSA) level and Gleason score/grade according to the International Society of Urological Pathology (ISUP), the group of T3/4 patients represents a heterogenous cohort, who can be assigned to high- or very-high-risk profiles. A sufficiently high RT dose to the prostate and concomitant long-term ADT are crucial to the success of oncological treatment. High-precision techniques such as intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) enable higher RT doses without a significant increase in gastrointestinal (GI) or genitourinary (GU) side effects and are now considered standard. Furthermore, optimal imaging for initial staging in terms of multiparametric MRI (mpMRI) and prostate-specific membrane antigen-based positron-emission tomography/CT (PSMA-PET/CT) is particularly important, as this can significantly influence the treatment strategy.