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Article

Role of Surgery in High-Risk Localized Prostate Cancer

1
Princess Margaret Hospital, Department of Urology and Surgical Oncology, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada
2
Urology Unit, Austin Hospital, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
3
Mount Sinai Hospital, Department of Urology and Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2010, 17(s2), 25-32; https://doi.org/10.3747/co.v17i0.705
Submission received: 2 June 2010 / Revised: 8 July 2010 / Accepted: 7 August 2010 / Published: 1 September 2010

Abstract

Men with high-risk localized prostate cancer (PCa) remain a challenge for clinicians. Until recently, surgery was not the preferred approach, in part because risk of subclinical metastatic disease, elevated rates of positive surgical margins, absence of randomized studies, and suboptimal cancer control did not justify the morbidity of surgery. No randomized data comparing surgery with radiation therapy are yet available. Data for and comparisons between treatment options should therefore be analyzed with extreme caution. When selecting the best treatment for patients with clinically localized high-risk PCa, considerations should include the life expectancy of the patient, the natural history of PCa, the curability of the disease, and the morbidity of treatment. High-grade PCa managed with noncurative intent greatly reduces life expectancy, but overall, it must also be remembered that radical prostatectomy (RP) and radiotherapy (RT) appear to have similar effects on quality of life. In this population, RP necessitates an extended pelvic lymph node dissection (PLND), but in selected cases, nerve-sparing is a therapeutic possibility and may offer a significant advantage over RT in terms of local control and—although absolutely not yet proved—maybe even in survival. One clear advantage is the ease of administering adjuvant or salvage external-beam RT (EBRT) after RP; conversely, salvage RP after failed EBRT is an exceedingly difficult surgery, with major complications. Surgery therefore has its place, but must be considered in the context of multimodality treatment and the risk of micrometastatic disease. Awaited trial results will help to further refine management in this group of patients.
Keywords: prostate neoplasm; pathology; prostatectomy; outcomes prostate neoplasm; pathology; prostatectomy; outcomes

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MDPI and ACS Style

Lawrentschuk, N.; Trottier, G.; Kuk, C.; Zlotta, A.R. Role of Surgery in High-Risk Localized Prostate Cancer. Curr. Oncol. 2010, 17, 25-32. https://doi.org/10.3747/co.v17i0.705

AMA Style

Lawrentschuk N, Trottier G, Kuk C, Zlotta AR. Role of Surgery in High-Risk Localized Prostate Cancer. Current Oncology. 2010; 17(s2):25-32. https://doi.org/10.3747/co.v17i0.705

Chicago/Turabian Style

Lawrentschuk, N., G. Trottier, C. Kuk, and A. R. Zlotta. 2010. "Role of Surgery in High-Risk Localized Prostate Cancer" Current Oncology 17, no. s2: 25-32. https://doi.org/10.3747/co.v17i0.705

APA Style

Lawrentschuk, N., Trottier, G., Kuk, C., & Zlotta, A. R. (2010). Role of Surgery in High-Risk Localized Prostate Cancer. Current Oncology, 17(s2), 25-32. https://doi.org/10.3747/co.v17i0.705

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