Global update on defining and treating high-risk localized prostate cancer with leuprorelin: a European perspective

High-risk prostate cancer can be defined as a cancer that, although clinically localized, will not be cured by monotherapy, whether surgery or radiation, and as a result will require some form of multimodal therapy, which will normally include luteinizing hormone-releasing hormone agonists. High-risk localized prostate cancer can be identified at three specific points during the management of the patient; before starting treatment (based on the profile of some predictive criteria, e.g. pathological features, prostate-specific antigen, PSA, level, and PSA velocity), on pathological evaluation of a surgical specimen taken during radical prostatectomy, or at the point of PSA relapse after radiotherapy or surgical therapy. Within Europe, therapeutic choice in patients identified as high-risk is normally made based on their age and life-expectancy. In those with a relatively long life-expectancy (>10 years) androgen suppression therapy (AST) should form part of a multimodal approach to treatment, but neoadjuvant hormonal therapy should be limited to use in combined hormonal therapy/radiotherapy protocols. AST can also be used to treat patients with PSA relapse. Several studies investigated the relative advantages of giving AST continuously vs intermittent therapy, but there are no notable differences between these approaches. AST monotherapy can be indicated in those patients with a shorter life-expectancy (<10 years), particularly if there are poor risk factors, e.g. a high PSA level (>50 ng/mL) or a short PSA doubling time (<12 months).