MANAGEMENT OF LOCALLY ADVANCED, AGGRESSIVE PROSTATE CANCER – CASE REPORT

Treatment of locally advanced prostate cancer (PC) represents a challenge before multidisciplinary team (MDT), typically includes not only local disease control but also systemic therapy and it should be tailored to each individual patient. We present a case of a 58-year-old man, whose PC presented itself as a locally advanced disease. Bearing in mind the patients’ age, absence of comorbidities but also his preferences, MDT decided that the rational first step in almost imminent multimodal treatment should be radical prostatectomy (RP). Due to several local adverse factors (positive surgical margins, extracapsular extension, seminal vesicle involvement) on RP specimen pathohistology and postoperative prostate specific antigen (PSA) of 6.69 ng/ml our MDT determined luteinizing hormone-releasing hormone (LHRH) agonist therapy in the course of 3 years plus immediate salvage radiotherapy. The therapy was well tolerated, although there was one episode of transitory radiation cystitis roughly one year after its completion. After 45 months of follow-up the patient is without signs of biochemical recurrence of PC, with fully restored testosterone level and good quality of life. The main task in advanced PC management, through multidisciplinary approach, is providing good oncological outcome while trying to reduce treatment morbidity and to maintain a good quality of life.