ORLANDO, FL (UroToday.com) - Dr. Howard Sandler argued for an integrated approach to prostate cancer beginning with radiotherapy (XRT). He described locally advanced CaP as cT3b disease with high Gleason score and PSA. One can’t ask more of local control and thus a multimodal treatment plan is needed. He was not in favor of trying to cure these patients with a surgical approach. They would still need XRT, he said. RTOG92-02, which was primarily in high risk patients showed a benefit to adjuvant hormone deprivation for disease specific survival, but not overall survival. He showed the flattening of the survival curves after 7 years as suggesting some benefit.

He showed the prospective EORTC 30001 trial of surgery in 40 men that perhaps supported the use of surgery. However, it was not a large series and complications remain an issue. In a large study of 15,000 patients, 9% had organ confined and 32% had specimen confined disease. Many failed over a 10 year period.

Dr. Sandler showed guidelines in the US and Europe that state that surgery should only be selectively applied to high risk CaP patients. If surgery is used, the patients should recognize that additional XRT will likely be needed.

Presented by Howard Sandler, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.