MDT (multi-disciplinary team) guidance for managing prostate cancer

o Faced with these figures, some patients would choose surgery, but many would choose
conservative management. 40
• The above findings are now updated to incorporate a further 3 years of follow up. At 12 years: 41
o 12.5% of the surgery group and 17.9% of the watchful waiting group had died of prostate
cancer (difference = 5.4%, 95%CI: 0.2−11.1).
o 19.3% of men in the surgery group and 26% of men in the watchful waiting group had been
diagnosed with distant metastases (difference = 6.7%, 95%CI: 0.2−13.2).
o This follow-up analysis was consistent with the previous findings. Radical prostatectomy can
reduce prostate cancer mortality and risk of metastases but no further benefits were seen
beyond 10 years of follow up in this study.
Neoadjuvant and adjuvant hormone therapy with radical prostatectomy
• At present, evidence suggests that the down-staging achieved with neoadjuvant hormone
therapy does not translate into improved DFS, and therefore cannot be recommended outside
of clinical trials. 42−45
• Similarly, there is currently no evidence that adjuvant hormone therapy provides a survival
46, 47
advantage for patients with pathologically proven localised disease.
Adjuvant radiotherapy after radical prostatectomy
• The EORTC 22911 study was designed to investigate benefit for immediate postoperative
radiotherapy in 502 patients with pT3 disease or positive surgical margins as opposed to
radiotherapy offered for biochemical or clinical relapse. 48
o After a median follow up of 5 years, biochemical progression-free survival (PFS) was
significantly improved in the immediate radiotherapy group (74.0% versus 52.6%;
p