[Surgical therapy of prostatic carcinoma]

Abstract

Radical prostatectomy (RPE) is considered to be the "gold standard" for the treatment of localized prostate cancer regardless the fact that up to now no prospective randomized trial has compared surgery against radiotherapy, brachytherapy or a surveillance strategy. Success of RPE mainly depends on patient selection. For patients without extraprostatic tumor growth results of RPE are excellent with a rate of 80-90% of patients without biochemical recurrence during a 10 year follow up. Despite current staging modalities including digital rectal examination, preoperative prostate specific antigen and Gleason score of the biopsy between 23-53% of patients will experience PSA recurrence during a 10 year follow up. Taken together all sources of presurgical information, accuracy of predicting pathological stage it 70%. Decision towards or against RPE based on this data may be difficult in the individual patient because it is unclear from which possible chance or percentage of cure RPE is the adequate treatment. Proper selection of patients is the key to success for surgical treatment of localized prostate cancer but we need more accurate information including molecular biology technology to predict the biological behavior of the tumor.