Editing Prostate Cancer: Management of Locally Advanced Prostate Cancer (section)

====== AUA ======
*'''2023 AUA Guidelines on Clinically Localized Prostate Cancer'''
**'''Adjuvant radiotherapy'''
***'''<span style="color:#ff0000">Should not be routinely recommended</span>'''
****'''<span style="color:#ff0000">Patients should be initially managed with PSA surveillance after radical prostatectomy</span>'''
***'''There may be a role for adjuvant radiation in patients with high-risk features (e.g., Gleason 8 to 10 disease with extraprostatic extension, positive lymph nodes); there were few of these patients in the trials'''

*'''2019 AUA guidelines (published before publication of RCTs comparing adjuvant vs. early salvage)'''
**'''ART should be offered if pT3a disease, positive margin(s), or seminal vesicle involvement'''
**'''SRT should be offered to patients with PSA or local recurrence after radical prostatectomy in whom there is no evidence of distant metastatic disease'''
**
*'''2022 EAU guidelines[https://uroweb.org/guidelines/prostate-cancer/chapter/treatment]''' 
**'''Only offer adjuvant intensity-modulated radiation therapy (IMRT)/volumetric modulated arc therapy (VMAT) plus image-guided radiation therapy (IGRT) to high-risk patients (pN0) with at least two out of three high-risk features (ISUP grade group 4–5, pT3, positive margins).'''
**'''PSA persistence after surgery'''
***'''Offer a prostate-specific membrane antigen positron-emission tomography (PSMA PET) scan to men with a persistent prostate-specific antigen > 0.2 ng/mL if the results will influence subsequent treatment decisions.'''
***'''Treat men with no evidence of metastatic disease with salvage radiotherapy and additional hormonal therapy.'''
**'''Recommendations for biochemical recurrence (BCR) after radical prostatectomy'''
***'''Offer early salvage intensity-modulated radiotherapy/volumetric arc radiation therapy plus image-guided radiotherapy to men with two consecutive PSA rises.'''
***'''Do not wait for a PSA threshold before starting treatment. Once the decision for SRT has been made, SRT (at least 64 Gy) should be given as soon as possible.'''