Radical prostatectomy for high-risk clinically localized prostate cancer: a prospective single institution series

Koupparis, Anthony; Grummet, Jeremy; Hurtado-Coll, Antonio; Bell, Robert H.; Buchan, Nicholas; Goldenberg, S. Larry; Gleave, Martin

doi:10.5489/cuaj.10057

Cited by 7 publications

(4 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the absence of a well‐conducted randomized trial, there is no definite evidence that one treatment is superior to the other. With modern surgical techniques in experienced hands, there is no increase in morbidity associated with RP in men with high‐risk compared with low‐risk prostate cancer . In our institution, men go home the next day after an open radical prostatectomy with the usual 4 weeks convalescence.…”

Section: Resultsmentioning

confidence: 99%

“…With modern surgical techniques in experienced hands, there is no increase in morbidity associated with RP in men with high-risk compared with low-risk prostate cancer. [41][42][43]106 In our institution, men go home the next day after an open radical prostatectomy with the usual 4 weeks convalescence. Surgery as monotherapy in high-risk disease (while effective in approximately 40-50% of men) is an antiquated idea and surgery should be considered part of a combined modality approach (where the extra modalities can sometimes be avoided).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Radical prostatectomy in high‐risk prostate cancer

Ischia

Gleave

2013

Int J of Urology

View full text Add to dashboard Cite

Abbreviations & AcronymsAbstract: One consistent finding in the studies regarding treating men with prostate cancer is that men with high-risk disease have the most to gain from treatment with curative intent. Men with high-risk or locally-advanced prostate cancer require treatment to the primary cancer or risk dying prematurely from their disease. Increasingly, combined androgen deprivation therapy + radiation treatment is seen as the standard treatment as a result of prospective studies in this space, and the perceived increased morbidity of radical prostatectomy in the setting of a "low" cure rate as monotherapy. In the absence of a well-conducted randomized trial, there is no definite evidence that one treatment is superior to the other. The advantages of radical prostatectomy are that it provides excellent local control of the primary tumor without an increase in morbidity, accurately stages the disease to guide further therapy, and removes benign sources of prostate-specific antigen so that failures can be promptly identified and subsequent treatment can be initiated in a timely manner. Although several guidelines recommend radiation treatment over radical prostatectomy as first-line treatment, there is no evidence that surgery is inferior and radical prostatectomy should remain part of any informed discussion regarding treatment options for men with high-risk prostate cancer.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Radical prostatectomy in high‐risk prostate cancer

Ischia

Gleave

2013

Int J of Urology

View full text Add to dashboard Cite

show abstract

“…[35]; in a series of 375 men with high‐risk disease treated by RP and stage‐dependent adjuvant ADT, the 5‐ and 10‐year CSS was 91.3% and 87.2% respectively. Koupparis et al [36] reported on 299 men with high‐risk disease treated at the Vancouver Prostate Centre, Canada. At a median of 4.7 years follow‐up, 70% of men were free of biochemical relapse and the disease‐specific survival (DSS) was 99%.…”

Section: Outcomes Of Rp For High‐risk Localised Prostate Cancermentioning

confidence: 99%

The role of surgery in high‐risk localised prostate cancer

et al. 2011

View full text Add to dashboard Cite

The optimal management of high‐risk localised prostate cancer is a major challenge for urologists and oncologists. It is clear that multimodal therapy including radical local treatment is needed in these men to achieve the best outcomes. External beam radiotherapy (EBRT) is an essential component of therapy either as a primary or adjuvant treatment. However, the role of radical prostatectomy (RP) is more controversial. Both methods are currently valid therapy options. There have been many individual studies of EBRT and RP in high‐risk disease, but no good quality large prospective randomized trials. In EBRT, combination with neoadjuvant plus long‐term adjuvant androgen‐deprivation therapy (ADT) has been conclusively shown to improve outcomes and is widely considered the standard of care. However, the role of RP has achieved recent prominence with several important studies. Published data from prospective randomized trials in patients after RP have shown that in men with adverse pathological features at surgery, the addition of adjuvant RT improves biochemical‐free and progression‐free survival. More recently, studies from large‐volume centres comparing EBRT and RP have provided intriguing suggestions of better outcomes with RP as the primary treatment. An important question therefore, is which of the two methods provides the best outcome in men with localised high‐risk disease. Crucially, does the combination of RP and selective adjuvant EBRT provide clinically significant better outcomes compared with EBRT alone? In this review we discuss the current evidence for the role of RP for high‐risk localised prostate cancer and define the parameters and urgent need for a prospective trial to test the role of surgery for this group of patients.

show abstract

“…Only RP can discern these patients, in whom monotherapy maybe the only treatment required, thereby avoiding overtreatment with EBRT plus 3 years of ADT. The wide dissection necessary, is capable of achieving specimen‐confined rates of up to 75% [7]. The ePLND can confer a biochemical survival advantage with negative nodes, and with early treatment, outcomes in those with positive nodes and seminal vesicle involvement can also be improved [8].…”

mentioning

confidence: 99%