Role of radical prostatectomy in the treatment of high-risk prostate cancer

Yossepowitch, Ofer; Eastham, James A.

doi:10.1007/s11918-008-0017-z

Cited by 6 publications

(7 citation statements)

References 50 publications

(36 reference statements)

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“…For some patients with HRCaP, surgical management may be an attractive option, as surgical monotherapy may provide cure for a portion of these patients (13)(14)(15)(16). Radical resection may be optimal in younger patients with greater than 10-year life expectancy.…”

Section: Discussionmentioning

confidence: 99%

“…A high level of technical expertise is mandatory during radical prostatectomy for HRCaP as these cases may prove more challenging to achieve negative margins. Experienced surgeons have noted no increased morbidity in HRCaP patients when compared to a lower risk cohort (14,16). Theoretically, given the lack of tactile feedback associated with robotic assisted surgery, concern exists about the use of robotics The Memorial Sloan Kettering group compared their PSM rates for LRP (n = 612) and (RRP n = 818) and found identical rates of 11%.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy

Harty¹,

Kozinn²,

Canes³

et al. 2013

Int. braz j urol.

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Objective: We compared positive surgical margin (PSM) rates for patients with high risk prostate cancer (HRCaP) who underwent open radical retropubic (RRP), robotic (RALP), and laparoscopic (LRP) prostatectomy at a single institution. Materials and Methods:We performed a retrospective review of our prospectively maintained IRB approved database identifying prostate cancer patients who underwent RRP, RALP, or LRP between January 2000 and March 2010. Patients were considered to have HRCaP if they had biopsy or final pathologic Gleason score ≥ 8, or preoperative PSA ≥ 20, or pathologic stage ≥ T3a. A positive surgical margin (PSM) was defined by the presence of tumor at the inked surface of the specimen. Patients who received neoadjuvant hormonal therapy and those who underwent a perineal prostatectomy were excluded from the study. Results: Of the 445 patients in this study, surgical technique for prostatectomy included RRP (n = 153), RALP (n = 152), and LRP (n = 140). PSM rate for the three groups were not different: 52.9% RRP, 50% RALP, and 41.4% LRP, (p = 0.13). The PSM rate did not differ when comparing RRP to a combined group of RALP and LRP (p = 0.16). Among patients with a PSM, there was no statistical difference between the three groups in terms of the number of patients with a pathologic stage of T3 or higher (p = 0.83). On univariate analysis, a higher preoperative PSA value was associated with a positive margin (p = 0.04). Conclusion: In this HRCaP series, the PSM rate did not differ based on the surgical approach. On univariate analysis, patients with a higher preoperative PSA value were more likely to have a PSM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy

Harty¹,

Kozinn²,

Canes³

et al. 2013

Int. braz j urol.

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“…The perception of increased technical difficulty and morbidity rate has been a major source of concern for RP in locally advanced PCa. However, realistic expectations regarding the success of RP alone or in the context of a multimodal approach should be provided during patient counseling [Yossepowitch and Eastham, 2008].…”

Section: Morbidity After Radical Prostatectomy For High-risk Cancersmentioning

confidence: 99%

Surgery for high-risk localized prostate cancer

Schmitges

Trinh

Walz

et al. 2011

Therapeutic Advances in Urology

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Treatment of men with high-risk prostate cancer (PCa) remains challenging for urologists. The complex natural history of high-risk PCa and the lack of specific and accurate definitions for high-risk disease impede treatment decision making. Historically, surgery in this patient group has been avoided based on the perception of ostensibly higher complication rates associated with inferior functional and oncological outcomes. To date, no randomized data comparing different therapy approaches have been made available. Several investigators have reported that continence rates in patients after radical prostatectomy (RP) for high-risk disease seem to be unaffected. Similarly, in a large proportion of these men, a nerve-sparing procedure can be performed without a significant negative impact on surgical margin rates and with comparable potency results. Moreover, extended pelvic lymph node dissection (EPLND) contributes to accurate pathological staging with a marginal effect on perioperative morbidity. With regards to the benefits of RP on local recurrence and cure rates, realistic expectations regarding the success of RP alone or in the context of a multimodal approach should be provided during patient counseling.

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“…Surgical case series reporting on outcomes for high‐risk disease have included men with high PSA levels, high Gleason grades and advanced stage or combinations of these risk factors. These studies have been well reviewed elsewhere [31–33]. Good outcomes have been reported from several different centres.…”

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

confidence: 98%

The role of surgery in high‐risk localised prostate cancer

et al. 2011

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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.

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Role of radical prostatectomy in the treatment of high-risk prostate cancer

Cited by 6 publications

References 50 publications

Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy

Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy

Surgery for high-risk localized prostate cancer

The role of surgery in high‐risk localised prostate cancer

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