European Journal of Cancer Supplements vol:3 issue:3 pages:305-308
ECCO 13 Education Book date:30 October - 3 November 2005
The definition of advanced prostate cancer is confusing: T4, T3b and also T3a prostate cancer stages are considered by many as advanced diseases and the treatment advocated is often hormonal treatment in combination with radiotherapy. Furthermore, clinically node positive, pathologically node positive and metastatic disease, either asymptomatic or symptomatic all belong to the group of advanced prostate cancers as well as hormone sensitive and hormone refractory prostate cancer. It is therefore not obvious how to distinguish early from advanced prostate cancer. To which category belongs a pT2-3 with negative surgical margins and PSA persistence, a pT2-3 with positive surgical margins, and a pT4? To which category belongs the radical prostatectomy patient with PSA (Prostate Specific Androgen) persistence, with early PSA rise, with late PSA recurrence or the patient who was treated with radiotherapy who never reached a PSA nadir below 1 ng/ml or who has PSA relapse after having reached an initial nadir? It is therefore proposed to use the terminology of early prostate cancer for the T1T2 cases and to consider as locally advanced all tumors that are clinically extending outside the prostate capsule (T3-4)for which local treatment could still be an option. Advanced prostate cancer is then the terminology to be used for the Tx N+M+ patients where cure cannot be obtained by local treatment.