What are the treatment protocols for intermediate risk of recurrence localized prostate cancer?

Updated: Dec 29, 2020
  • Author: Winston W Tan, MD, FACP; Chief Editor: E Jason Abel, MD  more...
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Answer

Answer

Intermediate risk of recurrence:

  • Treatment options for patients with clinical stage T2b-T2c, Gleason score 7 or PSA 10-20 ng/mL, who have a life expectancy < 10 y, include active surveillance or

  • Radiation therapy (doses of 78-80+ Gy) with 3D-CRT/IMRT with daily IGRT with or without short-term neoadjuvant/concomitant/adjuvant ADT for 4-6 mo with or without brachytherapy (recommended dose rate: 145 Gy for iodine-125 and 125 Gy for palladium-103) [13, 14]

  • Treatment recommendations for patients with a life expectancy ≥10 y include RP with PLND or

  • Radiation therapy (doses of 78-80+ Gy) with 3D-CRT/IMRT with daily IGRT with or without short-term neoadjuvant/concomitant/adjuvant ADT for 4-6 mo with or without brachytherapy (recommended dose rate: 145 Gy for iodine-125 and 125 Gy for palladium-103)

  • Intermediate-risk cancers consider combining brachytherapy (recommended dose rate: 145 Gy for iodine-125 and 125 Gy for palladium-103) with external beam radiation therapy (EBRT)(40-50 Gy) with or without 4-6 mo neoadjuvant/concomitant/adjuvant ADT

  • Administering ADT before, during, and after radiation prolongs survival [15]


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