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The Treatment of Locally Advanced Disease: An Overview Last Revised January 21, 1996 [since this was revised, methods may have evolved - not for diagnosis/treatment] Introduction | Defining locally advanced disease | The treatment options: an introduction | Lymph node positive or lymph node negative? | How did the disease escape the prostate? | Is node-positive disease really locally advanced? | Concluding remarks.
Similarly, the treatment of muscle invasive disease stage T2, No Mo is also universally same i. e. Radical Cystoprostatectomy (in men), radical cystectomy ± hysterectomy (in women) with bilateral pelvic LN dissection. (NCCN, EAU, guidelines). [3,4] However, significant variation in the treatment strategies is seen in the treatment of locally advanced - T3b, T4a and N1-N3 disease. Treatment of metastatic bladder cancer (extra pelvic nodal, visceral and distant metstasis) is also a difficult task.
Indeed, in patients with locally advanced or high-risk localised disease, the addition of neoadjuvant and adjuvant hormone therapy is now considered the standard of care for those men treated with radical radiotherapy. Although luteinising hormone-releasing hormone (LHRH) agonists have been used for many years as ADT, they may be associated with clinical flare and testosterone breakthrough. Newer hormonal agents continue to be developed, such as gonadotropin-releasing hormone antagonists, which reduce testosterone and prostate-specific antigen levels more rapidly than LHRH agonists, without testosterone flare. This review examines ADT use in combination with radiotherapy to improve outcomes in localised or locally advanced disease.
Due to the complexity of care involved, it is very important for the multidisciplinary cancer team (consisting of a surgeon, pathologist, radiation oncologist, medical oncologist) to coordinate not only with each other but also with primary care physicians and specialist care teams to implement and deliver comprehensive, efficient, and patient-centered care. Selecting the most efficient systemic therapy approach for locally advanced disease.