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Prostate cancer, high-risk localised

Prostate cancer →

Radiotherapy with two to three years of hormone therapy (sometimes with abiraterone), or surgery, after a PSMA PET scan has shown the cancer has not spread; then PSA checks for life.

061 yr182 yr303 yr42Months from diagnosis · solid bar = shortest typical duration, hatched = up to the longest · arrow = continues for yearsPhaseDiagnosis and stagingDiagnosis and tests · 4-8 wkAndrogen deprivation therapySystemic therapy · 78-156 wkRadiotherapyRadiotherapy · 1-8 wk · alongsideAbiraterone (very high risk)Systemic therapy · 104 wk · alongsidePSA surveillanceSurveillance · yearsRadiotherapy with hormone therapy, or radical prostatectomy?decision 1Diagnosis and testsSystemic therapyRadiotherapySurveillance
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Typical sequence for High-risk localised disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

  1. 1. Diagnosis and staging
    weeks 0-8

    PSA, MRI-targeted biopsy with Gleason grading, and a PSMA PET-CT, which replaced bone scan and CT for staging (proPSMA).

    Source
    Decision: Radiotherapy with hormone therapy, or radical prostatectomy?
    • Radiotherapy + 18-36 months ADT (+ abiraterone if very high risk)
    • Radical prostatectomy with node dissection, then radiotherapy if PSA rises or margins are involved
  2. 2. Androgen deprivation therapy
    weeks 4-160

    GnRH agonist or antagonist injections for 18-36 months, starting before radiotherapy.

    Source
  3. 3. Radiotherapy
    weeks 4-12 (alongside the previous phase)

    External beam radiotherapy to the prostate (and pelvic nodes) in 20 fractions over 4 weeks, or 5 fractions of stereotactic radiotherapy; brachytherapy boost in some centres. Radical prostatectomy is the surgical alternative.

    Source
  4. 4. Abiraterone (very high risk)
    weeks 4-108 (alongside the previous phase)

    Two years of abiraterone with prednisolone alongside ADT improved survival in STAMPEDE for node-positive or very high-risk disease.

    Source
  5. 5. PSA surveillance
    from week 108, continues for years

    PSA every 6-12 months for at least 5 years then yearly; testosterone recovery after ADT; bone health monitoring.

    Source

Sources