Of the various treatment options available for the localized disease, the final decision is taken by the oncologist after assessing the patient’s condition and comorbidities.
For the treatment of localized disease, we first have to risk stratify the patient based on the T and N status, PSA, and Gleason’s grade.
The localised disease can be divided into very low or low risk, intermediate risk, and high or very high risk.
Very low or low-risk disease includes cases with T1 and T2a disease, Gleason’s grade 6 or less and PSA less than 10.
Intermediate risk includes cases with T2b or T2c disease, Gleason’s grade 7 and PSA 10 to 20.
High or very high-risk disease includes cases with one of the following, T3 or T4 disease, Gleason’s grade 8 to 10 or PSA more than 20.
The treatment of low or very low-risk disease depends upon the life expectancy of the patient.
If the life expectancy is less than 10 years, observation is preferred. Whereas, if the life expectancy is more than 10 years, the treatment options are active surveillance, radiation therapy or radical prostatectomy.
For intermediate risk disease, the treatment options are radical prostatectomy or radiation therapy. Observation may be considered in some cases with life expectancy less than 10 years.
And rarely, androgen deprivation therapy may be added in some cases.
For high or very high-risk disease, the treatment options are radiation therapy, radical prostatectomy or androgen deprivation therapy, alone or in combination.
In the case or node-positive disease that is N1 disease, androgen deprivation therapy with or without radiation therapy is used.
This brings us to the end of the Localised/Locally advanced prostate cancer treatment.
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