Difficult clinical cases of locally advanced
prostate cancer at high-risk of progression should be discussed during a collegial decision-making process with different clinical specialists (surgeon, radiotherapist, oncologist, chemotherapist). Scientific consensus exists to give an adjuvant
therapy after initial curative local treatment in patients with unfavourable prognostic features. For patients with locally advanced
prostate cancer extending beyond the
capsule (pT3) or with
positive surgical margins, studies have shown that immediate postoperative
radiotherapy is to eradicate the microscopic disease left in the surgical bed. Studies have shown the potential benefit of cytotoxic
chemotherapy in terms of overall survival and median time to progression in patients with metastatic
hormone-refractory
prostate cancer. Active clinical research is underway to study neoadjuvant systemic
chemotherapy before radical
prostatectomy. There are also currently several clinical trials that are investigating the addition of
chemotherapy in patients at high-risk of progression in the postprostatectomy setting.
Antiandrogen therapy after radical
prostatectomy has been shown in randomised studies to significantly reduce the risk of objective
clinical progression in patients with high-risk localized
prostate cancer. Immediate hormonal
therapy with
bicalutamide is a valuable therapeutic option in men having
prostate cancer with such clinicopathological features.