New surgical approaches for clinically high-risk or metastatic prostate cancer

A considerable number of individuals with prostate cancer (PCa) still harbor locally-advanced and metastatic disease. Although such men were initially not considered eligible for local treatment, the role of radical prostatectomy (RP) has been recently reassessed. Areas covered: This review analyses currently published evidences regarding new surgical approaches for clinically high-risk PCa individuals, as well as the role of cytoreductive surgery in the metastatic setting. The role of robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection will be evaluated with regards to perioperative, oncologic, as well as functional outcomes. Expert commentary: RARP is a feasible approach in PCa patients regardless of the presence of high-risk disease features and can achieve optimal short-term oncologic outcomes and acceptable short/intermediate-term functional outcomes, that are comparable to those reported for open RP. Extended pelvic lymph node dissection can be performed in this setting and should be recommended for all high-risk PCa patients. The overall rate of complications in contemporary men treated with RARP for high-risk disease is not negligible. Cytoreduction in the oligo-metastatic setting is feasible and relatively safe, although evidence is scarce to recommend its widespread adoption. In consequence, longer follow-up data and, ideally, randomized controlled trials are needed.

Expert review of anticancer therapy. 2017 Sep 01 [Epub ahead of print]

Paolo Dell'Oglio, Armando Stabile, Giorgio Gandaglia, Emanuele Zaffuto, Nicola Fossati, Marco Bandini, Nazareno Suardi, Pierre I Karakiewicz, Shahrokh F Shariat, Francesco Montorsi, Alberto Briganti

a Department of Urology and Division of Experimental Oncology , URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute , Milan , Italy., b Cancer Prognostics and Health Outcomes Unit , University of Montreal Health Center , Montreal , Canada., c Department of Urology , Medical University of Vienna and General Hospital , Vienna , Austria .