PURPOSE OF REVIEW: Surgery for high-risk prostate cancer (PCa) is applied frequently nowadays.
Nevertheless, this approach is still surrounded by many controversies. The present review discusses the most recent literature regarding surgery for high-risk PCa.
RECENT FINDINGS: As there is no standard definition of high-risk PCa, outcome comparison between series and treatment approaches is hampered. Nevertheless, recent radical prostatectomy series have shown excellent cancer-specific survival in patients with high-risk PCa. Even for very-high-risk PCa (cT3b-T4 or any cT, N1), surgery may be applied to highly selected patients as a first step of a multimodality approach. Recent experience with robot-assisted surgery opens new possibilities for a minimally invasive approach in this field.Patient selection for surgery was also addressed in recent studies. Excellent cancer-specific survival is seen when specimen-confined PCa is found at final histopathology; a recently published nomogram enables the prediction of specimen-confined disease. Another issue in high-risk PCa is the impact of age and comorbidities on cancer-specific and overall mortality. In a recent study, it was shown that patients with low comorbidity scores, even when at least 70 years old, had a significant risk of dying from their cancer and may benefit most from a surgical approach. A modified extended pelvic lymphadenectomy template was presented, providing optimal removal of positive lymph nodes.
SUMMARY: Radical prostatectomy with extended pelvic lymphadenectomy delivers very good cancer-related outcomes in high-risk and very-high-risk PCa, often within a multimodal approach. Minimally invasive surgery and improved patient selection will be key to further improve oncological and functional outcomes.
Written by:
Joniau S, Tosco L, Briganti A, Vanden Broeck T, Gontero P, Karnes RJ, Spahn M, Van Poppel H. Are you the author?
Urology, Department of Development and Regeneration, University Hospital of Leuven, Leuven, Belgium; Department of Urology, Vita-Salute San Raffaele Hospital, Milan, Italy; Department of Urology, University of Turin, Turin, Italy; Department of Urology, Mayo Clinic, Rochester, Minnesota, USA; Department of Urology, Inselspital, Bern, Switzerland.
Reference: Curr Opin Urol. 2013 Jul;23(4):342-8.
doi: 10.1097/MOU.0b013e3283620f60
PubMed Abstract
PMID: 23702565
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