High-risk localized prostate cancer: role of radical prostatectomy

Abstract

Purpose of review: The paucity of randomized trials comparing curative management strategies for high-risk prostate cancer makes treatment decisions in this patient population difficult. Although in the past, high-risk patients have primarily been sent for radiation therapy due to concerns that surgery was not likely to be curative and associated with high side-effect profile, there is renewed interest in radical prostatectomy as the primary treatment for high-risk disease.

Recent findings: Multiple case series have recently been reported that demonstrate the long-term efficacy of radical prostatectomy in a high-risk population with 15-year prostate cancer-specific survival of over 80%. Comparisons of different treatment options using nonrandomized trials demonstrate improved outcomes with surgery compared with watchful waiting or radiation therapy.

Summary: Radical prostatectomy is an acceptable treatment alterative, which provides long-term durable disease control for men with high-risk prostate carcinoma.