The management of high risk XXXX .

@entity1 @entity263 @entity342 @entity1486
PURPOSE: A major problem that urologists encounter is the recurrence of @entity263 after local therapy or the failure of primary therapy. There is no consensus on the treatment of these groups of @entity1 . The role of radiotherapy, hormonal therapy or chemotherapy must be defined. MATERIALS AND METHODS: A comprehensive literature review of the current management of recurrence after primary therapy in @entity263 was performed using MEDLINE, a review of current urology and oncology journals, and abstracts from recent urology meetings. The data collected focused on the role of radiotherapy, hormonal therapy and chemotherapy in this setting. RESULTS: Defining a high risk group of @entity1 using Gleason score, seminal vesicle or pelvic lymph node involvement and @entity1486 recurrence time is important for treating the problem early in disease course. Adjuvant radiotherapy cannot offer a survival advantage but it provides longer biochemical recurrence-free survival. Early administration of salvage radiotherapy in adequate doses provides a success rate similar to that of adjuvant radiotherapy in @entity1 with low @entity1486 . Although there is no good evidence that early @entity342 deprivation definitely prolongs @entity1 survival, increased time to progression in addition to excellent palliation with early hormonal therapy was reported in the majority of trials. Early trials of the use of chemotherapy showed improved survival rates with adjuvant chemotherapy alone or with a combination of hormonal therapy, especially in @entity1 with nonmetastatic disease. CONCLUSIONS: Although analysis of current literature revealed that @entity1 who have recurrence after primary therapy would benefit from radiotherapy, hormonal therapy, chemotherapy or a combination of therapies, additional prospective randomized studies are needed to support these findings.
