European urology supplements vol:4 issue:4 pages:12-14
Although prostate cancer is now most often detected in its early stages, still a relevant number of patients are found to have locally advanced disease at presentation. The clinical staging is done with digital rectal examination but even when in addition ultrasound, PSA level and prostate biopsy pathology gives additional information, over- and understaging are common. Overstaging of T3 cancer is occurring in 15 to 25%. These patients, who have organ-confined cancers can easily be cured with surgery alone  and .
The goals of treatment of locally advanced T3 prostate cancer are to cure the disease, prolong survival or metastasis free survival and improve quality of life. The treatment of T3 prostate cancer can be radical prostatectomy (RP), radiotherapy (RT), hormonotherapy (HT) and combinations.
Years ago T3 prostate cancer was seen as an indication for hormonal treatment because the disease was often disseminated. When the results of radical prostatectomy series for clinically T3 prostate cancer became available, this concept has changed , ,  and .
The EAU guidelines on treatment of prostate cancer now stipulate that radical prostatectomy in locally advanced prostate cancer is an option for selected patients with small unilateral T3 cancers with a PSA lower than 20 ng/ml, a Gleason score lower than 8 and a life expectancy of more than 10 years . In T3 cancer the surgery needs to be extensive and warrants special expertise.