This protocol covers male patients with locally advanced prostate cancer at clinical stage cT3–4, with no regional lymph node involvement (cN0) and no distant metastases (M0). At this stage, combining local and systemic treatment provides the best outcomes in patients who are fit enough to receive both.

Clinical Scenario

Locally advanced disease (cT3–4) means the tumour has extended beyond the prostatic capsule or involves adjacent structures, yet has not spread to regional lymph nodes (cN0) or distant sites (M0). This staging in male patients calls for an aggressive, multimodal strategy rather than any single modality alone.

Treatment Approach — partial overview

Management centres on either a surgical approach or radiation-based therapy combined with long-term hormonal suppression. For patients who carry multiple high-risk features, further systemic agents may be added to the radiation and hormonal backbone. The complete protocol defines the full eligibility criteria, sequencing, and decision points.

References

A local treatment combined with a systemic treatment provides the best outcome, provided the patient is fit enough to receive both.
Offer patients with cN0 disease intensity-modulated radiation therapy (IMRT)/volumetric modulated arc therapy (VMAT) plus image-guided radiation therapy in combination with long-term androgen deprivation therapy (ADT).
Offer RP to selected patients with cN0 disease as part of multi-modal therapy.
Offer long-term ADT for at least two years.
Offer IMRT/VMAT plus IGRT to the prostate in combination with long-term ADT and two years of abiraterone to cN0M0 patients with ≥ 2 high-risk factors (cT3-4, Gleason ≥ 8 or prostate-specific antigen ≥ 40 ng/mL).
Offer patients with cN0 disease and good urinary function, IMRT/VMAT plus IGRT with brachytherapy boost (either high-dose rate or low-dose rate), in combination with long-term ADT.

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Treatment of Locally Advanced Prostate Cancer (cT3–4, cN0, M0) in Male Patients