RT: radiation therapy; RP: radical prostatectomy; ADT: androgen deprivation therapy.
* We consider patients with pelvic nodal metastases to have metastatic and not locally advanced disease.
¶ High-volume metastatic disease includes the presence of visceral metastases or 4 or more bone metastases, at least one outside the vertebral bodies and pelvis. Another feature of high-risk disease is Gleason score 8 to 10 disease or de novo metastatic disease at clinical presentation.
Δ High-risk biochemical recurrence after RP: PSA doubling time <1 year or pathologic Gleason score 8 to 10. High risk biochemical recurrence after RT: Interval to biochemical recurrence <18 months, or a clinical Gleason score 8 to 10.
◊ Prednisone or prednisolone.
§ Selected males with low burden disease could be considered candidates for triplet therapy if they are relatively young, candidates for docetaxel, with no comorbidity, and had a higher anticipated cancer specific mortality despite having low-burden disease (eg, a short time to relapse with metastatic disease after primary local therapy).