Contemporary management of locally advanced prostate cancer: a narrative review and expert perspective

Rákkutatás · Prostate cancer

EBRT combined with long‑term androgen deprivation therapy (ADT) is the standard of care for locally advanced prostate cancer, with abiraterone addition for selected high‑risk cases and ongoing investigation of androgen‑receptor‑pathway inhibitors and chemotherapy in this setting.

Locally advanced prostate cancer (PCa) encompasses a heterogeneous group of patients, including those with clinical stage T3–T4 disease and/or regional lymph node involvement (cN1), without distant metastases. While curative‑intent treatment remains the goal in many cases, optimal management strategies are still subject to debate due to limited high‑level evidence and variability in clinical guidelines. This narrative review summarizes current treatment guidelines, appraises recent clinical evidence, and offers an expert perspective on contemporary management strategies for patients with locally advanced PCa. The established standard of care remains external beam radiotherapy (EBRT) combined with long‑term androgen deprivation therapy (ADT), with the addition of abiraterone now recommended for selected high‑risk cases. Radical prostatectomy (RP), although not yet supported by randomized trials, may provide oncological and functional benefits in carefully chosen patients and is increasingly being incorporated into multimodal treatment strategies. The role of intensified neoadjuvant or adjuvant systemic therapies, however, remains under investigation. Current management of locally advanced PCa requires individualized decision‑making based on modern imaging modalities, patient characteristics, tumor biology, and available resources. While EBRT‑based multimodal concepts are mainly the preferred treatment, RP‑based multimodal concepts play an important role in selected cases. Emerging systemic therapies and advanced imaging may further refine treatment strategies in the near future.

Understanding the most effective multimodal strategies for locally advanced prostate cancer is essential to optimize patient outcomes, reduce overtreatment, and improve quality of life. This review clarifies current guideline consensus and identifies areas where further evidence is needed.

Bizonyítékszint: Klinikai vizsgálat. Formális klinikai vizsgálati eredmény.

Eredeti forrás

Kapcsolódó jelek