Locally advanced prostate cancer treated with radiotherapy and androgen deprivation.

BACKGROUND: A 60-year-old man, with a 2-year history of lower-urinary-tract symptoms (frequency and reduced flow) and perineal discomfort, presented with a serum PSA level of 42 ng/ml.

INVESTIGATIONS: Digital rectal examination, transrectal ultrasound, prostate biopsy (8 cores), prostate and pelvic MRI, renal ultrasound and bone scan.

DIAGNOSIS: cT3b, N0, M0 prostate cancer (Gleason score 7 [4 + 3]).

MANAGEMENT: Hormonal down-staging with bicalutamide 150 mg/day for 3 months, then conformal radiotherapy (70 Gy over 7 weeks) with adjuvant bicalutamide 150 mg/day, to be continued until disease progression. Breast radiotherapy administered over a 5-day period at a dose of 15 Gy to reduce nonsteroidal antiandrogen-associated gynecomastia and breast pain.