European Urology, Volume 53 Issue 1, February 2008, Pages 253-259
Published online: 01 February 2008
Keywords: Gleason score, High-grade, Locally advanced, Prostate cancer, Radical prostatectomy, Survival
To clarify the role of radical prostatectomy (RP) in the treatment of locally advanced and high-grade prostate cancer.
Literature search of Medline publications on surgery for locally advanced and high-grade prostate cancer.
In patients with locally advanced disease, the cancer-specific survival rate after RP at 5- and 10-yr follow-up was 85–100% and 57–91.6%, respectively. The overall survival rate at 5 and 10 yr was>75% and 60%, respectively. In patients with high-grade prostate cancer (Gleason score≥8), the biochemical recurrence-free survival after RP at 5 and 10 yr of follow-up was 51% and 39%, respectively. Nomograms and modern imaging techniques are useful in predicting pathologic stage, presence of positive lymph nodes, or seminal vesicle involvement. These allow physicians to recognise those patients with locally advanced disease who are most likely to benefit from surgical treatment. Downgraded and organ- or specimen-confined high-grade tumours can have a good prognosis after surgery. The prostate-specific antigen value and the percent positive biopsy cores can be helpful in identifying men with high-grade prostate cancer most likely to benefit from RP.
It is likely that surgery has a role in the treatment of locally advanced and high-grade tumours. However, it is necessary and urgent to have randomised trials assessing survival and quality of life when RP is and is not included in the multimodality treatment.
Take Home Message
Radical prostatectomy is becoming an accepted initial treatment modality for patients with locally advanced and high-grade prostate cancer. Although adjuvant or salvage radiotherapy or hormonal therapy are often required, oncologic outcomes are consistently good.
Keywords: Gleason score, High-grade, Locally advanced, Prostate cancer, Radical prostatectomy, Survival.
Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
Corresponding author. University Hospital K.U. Leuven, Department of Urology, B-3000 Leuven, Belgium. Tel. +32 16 346687; Fax: +32 16 346931.
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© 2007 European Association of Urology, Published by Elsevier B.V.