Results of surgery for high-risk prostate cancer

Steven Joniau, Lorenzo Tosco, Alberto Briganti, Thomas Van den Broeck, Paolo Gontero, R. Jeffrey Karnes, Martin Spahn, Hein Van Poppel

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)342-348
Number of pages7
JournalCurrent Opinion in Urology
Volume23
Issue number4
DOIs
Publication statusPublished - Jul 10 2013

Keywords

  • cancer-specific survival
  • high-risk prostate cancer
  • surgery

ASJC Scopus subject areas

  • Urology

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    Joniau, S., Tosco, L., Briganti, A., Van den Broeck, T., Gontero, P., Karnes, R. J., Spahn, M., & Van Poppel, H. (2013). Results of surgery for high-risk prostate cancer. Current Opinion in Urology, 23(4), 342-348. https://doi.org/10.1097/MOU.0b013e3283620f60