Adjuvant Treatment for High-Risk Operable Prostate Cancer (Report‪)‬

1. Introduction According to the pre-operative d'Amico criteria, patients with localized prostate cancer (Pca) (PSA20 ng/mL, Gleason 8-10, T2c to T4 disease) are considered to be at high risk, with recurrence rates ranged from 50 to 100 percent after a local therapy alone, especially if they are young, healthy and with a long life expectancy. For these patients, prostate cancer specific survival is significantly compromised [1] and surgery alone won't be able to control the disease. Instead, these patients can show signs of residual disease at the primary site with likely persistent androgen-dependent and independent subpopulation of malignant cells. They also have high risk to develop asymptomatic or symptomatic metastases. In this case, adjuvant approach may be especially important. It is well known that, in breast or colon cancers, the use of adjuvant treatment after surgery has shown a beneficial improvement in survival [2-6]. In Pca, randomized studies are needed to evaluate the potential effect of adjuvant therapy in these high-risk patients. The optimum adjuvant management for high-risk patients after radical prostate ctomy (RP) may consist in androgen deprivation therapy (ADT), chemotherapy, prostate bed radiotherapy (RT) or some combination of these modalities.