Surgery vs Radiation for High-Risk Prostate Cancer
High-risk PCa is defined as bilaterally clinically palpable tumors (during the digital rectal examination), with PSA levels of 20 ng/mL or higher or a Gleason score of 8 or higher.
However, while high-risk prostate cancer (PCa) is well defined, less defined is what it is the best treatment in this patients.
Radical prostatectomy or radiation therapy?
While we have one conclusive randomized controlled trial showing no difference between surgery and radiotherapy at 10-year follow up, we have not any data applicable to high-risk patients. Then we cannot conclude if in high-risk patients it is better radiation therapy or radical surgery.
The choice has to be done on the basis of the patient age, co-morbidities and life expectancy. The side effects of both procedures have to be taken into consideration in order to obtain a patient-tailored, aware and shared treatment.
In the near future, newer diagnostic tools such as multiparametric MRI as well as genetic prognostic tests may help us better individualize the appropriate therapy.
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