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How to manage patients with prostate cancer (PCa) with biochemical recurrence (BCR) following primary curative treatment is a controversial issue. Importantly, this prostate-specific antigen (PSA)-only recurrence is a surrogate neither of PCa-specific survival nor of overall survival. Physicians are therefore challenged with preventing or delaying the onset of clinical progression in those deemed at risk, while avoiding over-treating patients whose disease may never progress beyond PSA-only recurrence. Adjuvant therapy for radical prostatectomy (RP) or local radiotherapy (RT) has a role in certain at-risk patients, although it is not recommended in low-risk PCa owing to the significant side-effects associated with RT and androgen deprivation therapy (ADT). The recommendations for salvage therapy differ depending on whether BCR occurs after RP or primary RT, and in either case, definitive evidence regarding the best strategy is lacking. Options for treatment of BCR after RP are RT at least to the prostatic bed, complete or intermittent ADT, or observation; for BCR after RT, salvage RP, cryotherapy, complete or intermittent ADT, brachytherapy, high-intensity focused ultrasound (HIFU), or observation can be considered. Many patient- and cancer-specific factors need to be taken into account when deciding on the best strategy, and optimal management depends on the involvement of a multidisciplinary team, consultation with the patient themselves, and the adoption of an individualised approach. Improvements in imaging techniques may enable earlier detection of metastases, which will hopefully refine future management decisions. [ABSTRACT FROM AUTHOR]

Introduction: Before radical prostatectomy (RP), a nomogram [Briganti et al., Eur Urol 2012;61:584-592] permits to measure the probability of specimen-confined (SC) disease (pT2-pT3a, node negative with negative margins) in high-risk prostate cancer (PCa). The aim of our study was to perform an external validation of this nomogram. Materials and Methods: Between 2007 and 2011, 623 patients with high-risk PCa (prostate-specific antigen (PSA) >20 ng/ml and/or biopsy Gleason score ≥8 and/or clinical stage T3) underwent RP and pelvic lymph node dissection at tertiary referral centers. Multivariable logistic regression models predicting the presence of SC disease were built in; we then used the area under curve of the receiver operating characteristic analysis to quantify accuracy of the nomogram to predict SC disease. The extent of over- or underestimation was evaluated within calibration plots. Results: 29% (181/623) of men had SC disease at RP. Preoperative PSA, biopsy Gleason score and stage differed significantly (all p < 0.001) between men with SC disease and those without. External validation of the nomogram showed an acceptable accuracy (area under curve: 66.3, 95% CI 62.4-70%) and a perfect calibration plot. Conclusions: The external cohort validates the original nomogram, with perfect calibration characteristics. The adequate although reduced accuracy may reflect the wide spectrum and behavior of the so-called high-risk PCa. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Radical prostatectomy (RP) in patients with locally advanced (cT3) prostate cancer (PCa) is considered an optional therapy. Aim: To evaluate outcomes of surgery for cT3 disease and to compare results with those of patients treated for cT1-T2 PCa. Patients and Methods: Data of 74 consecutive patients with cT3 N0M0 PCa who underwent RP were compared to those of 425 consecutive unselected patients who underwent surgery for cT1-T2 N0M0 disease. Results: cT3: The pathological report showed a pathological downstaging in 16.3% of cases. Continence rate was 65.5%, potency rate was 38.8%, 5-year PSA-free survival was 61.9%, 5-year cancer-specific survival was 95.2%. cT1-T2: The pathological report showed a clinical downstaging in 39.1%. Continence rate was 70.8%, potency rate was 56.2%, 5-year PSA-free survival was 67.4%, 5-year cancer-specific survival was 96.0%. Conclusions: cT3 PCa presents challenges for the uro-oncologist since standard treatment is still under debate. RP in well-informed patients is a procedure with acceptable morbidity and should be at least a first part of a multimodality approach. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]