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- Title
Treatment and Staging Intensification Strategies Associated with Radical Prostatectomy for High-Risk Prostate Cancer: Efficacy Evaluation and Exploration of Novel Approaches.
- Authors
Reitano, Giuseppe; Ceccato, Tommaso; Botti, Simone; Bruniera, Martina; Carrozza, Salvatore; Bovolenta, Eleonora; Randazzo, Gianmarco; Minardi, Davide; Ruggera, Lorenzo; Gardi, Mario; Novara, Giacomo; Dal Moro, Fabrizio; Zattoni, Fabio
- Abstract
Simple Summary: High-risk prostate cancer is an aggressive disease, and its treatment can be complex and require the involvement of several specialists. Advances in imaging and therapies in this field can improve survival and help physicians choose the best personalized approach that maintains quality of life. This article summarizes the most recent publications on this condition and its treatments, aiming to provide an updated guide for managing patients with prostate cancer who experience a higher risk of progression and death. The management of high-risk prostate cancer (PCa) presents a significant clinical challenge, often necessitating treatment intensification due to the potential presence of micrometastases. While radical prostatectomy (RP) constitutes one of the primary treatment modalities, the integration of neoadjuvant and adjuvant therapies suggests a paradigm shift towards more aggressive treatment strategies, also guided by new imaging modalities like positron emission tomography using prostate-specific membrane antigen (PSMA-PET). Despite the benefits, treatment intensification raises concerns regarding increased side effects. This review synthesizes the latest evidence on perioperative treatment intensification and de-escalation for high-risk localized and locally advanced PCa patients eligible for surgery. Through a non-systematic literature review conducted via PubMed, Scopus, Web of Science, and ClinicalTrials.gov, we explored various dimensions of perioperative treatments, including neoadjuvant systemic therapies, adjuvant therapies, and the role of novel diagnostic technologies. Emerging evidence provides more support for neoadjuvant systemic therapies. Preliminary results from studies suggest the potential for treatments traditionally reserved for metastatic PCa to show apparent benefit in a non-metastatic setting. The role of adjuvant treatments remains debated, particularly the use of androgen deprivation therapy (ADT) and adjuvant radiotherapy in patients at higher risk of biochemical recurrence. The potential role of radio-guided PSMA lymph node dissection emerges as a cutting-edge approach, offering a targeted method for eradicating disease with greater precision. Innovations such as artificial intelligence and machine learning are potential game-changers, offering new avenues for personalized treatment and improved prognostication. The intensification of surgical treatment in high-risk PCa patients is a dynamic and evolving field, underscored by the integration of traditional and novel therapeutic approaches. As evidence continues to emerge, these strategies will refine patient selection, enhance treatment efficacy, and mitigate the risk of progression, although with an attentive consideration of the associated side effects.
- Subjects
RISK assessment; CANCER relapse; LYMPHADENECTOMY; DIFFUSION of innovations; RADIOTHERAPY; RADICAL prostatectomy; ARTIFICIAL intelligence; PROSTATE tumors; TREATMENT effectiveness; POSITRON emission tomography; COMBINED modality therapy; PROSTATE-specific membrane antigen; TUMOR classification; INDIVIDUALIZED medicine; MACHINE learning; PERIOPERATIVE care; DISEASE progression; EVALUATION; DISEASE risk factors
- Publication
Cancers, 2024, Vol 16, Issue 13, p2465
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16132465