Management of locally advanced XXXX : a European consensus.

@entity1 @entity263 @entity66 @entity5 @entity4397 @entity3 @entity1486
This report summarises the findings of a European Consensus Group review of current standards of care in locally advanced @entity263 defined as (a) untreated @entity5 extending clinically beyond the prostatic capsule in @entity1 with no evidence of lymph node invasion or distant metastases, and (b) @entity66 remaining after local treatment with positive surgical margins, @entity3 , persistent @entity1486 and/or secondary @entity1486 relapse. There was no overall consensus as to the standard of care in clinically apparent locally advanced @entity263 . It was agreed, however, that hormonal therapy (e.g. with a gonadotrophin releasing hormone analogue [ @entity4397 ]) represents a valid treatment in these @entity1 . Treatment practices and regimens vary considerably between European countries, but @entity4397 is widely used, either alone or in combination with antiandrogens. Hormonal therapy alone is a valid option, though the optimal modality, timing and duration of treatment remain to be defined. Adjuvant therapy with a @entity4397 has been shown to improve survival in @entity1 undergoing external beam radiotherapy. It is a viable option after prostatectomy in @entity1 with persistent or secondary relapsing @entity1486 . It was determined that optimal treatment will be different according to @entity1486 , clinical staging and Gleason score, and the treatment of locally advanced disease should be individually tailored after discussion between physician and @entity1 . In many instances, @entity1 prefer and expect some form of treatment in preference to watchful waiting. Treatment nomograms such as the Kattan nomograms provide precise, comprehensive and invaluable tools for everyday use and may be used to predict outcomes and guide treatment decisions.
