The role for surgery in high-risk prostate cancer.

High-risk prostate cancer (PCa) refers to a very heterogeneous subgroup of disease. Recent series have shown very promising results of radical prostatectomy (RP)-alone or part as a multimodality approach-in patients with high-risk PCa, with satisfactory survival curves even though biochemical recurrence rate was high.

Adjuvant treatment (radiotherapy (RT) alone or combined with androgen deprivation) was necessary in 20 to 54 % of patients, notably in cases with positive surgical margins. As for functional outcomes, urinary continence was preserved in about 92 % of cases and overall potency in 60 %. When comparing RP versus RT as primary treatment for high-risk PCa, a recent meta-analysis found surgery to be associated with an improved cancer-specific mortality compared with RT. In selected high-risk PCa young patients, surgery appears to be a valid option. Patients should however be informed of the possibility of adjuvant treatment, as part of a multimodal approach.

Wiener medizinische Wochenschrift (1946). 2015 Sep 23 [Epub ahead of print]

Cécilia Lanchon, Shahrokh F Shariat, Morgan Rouprêt

Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, 83 Bvd Hôpital, 75013, Paris, France. , Department of Urology, Medical University of Vienna, Vienna, Austria. , Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, 83 Bvd Hôpital, 75013, Paris, France.  

PubMed