Wiener Medizinische Wochenschrift

, Volume 165, Issue 19–20, pp 395–400 | Cite as

The role for surgeryin high-risk prostate cancer

  • Cécilia Lanchon
  • Shahrokh F. Shariat
  • Morgan Rouprêt
main topic

Summary

High-risk prostate cancer (PCa) refers to a very heterogeneous subgroup of disease. Recent series have shown very promising results of radical prostatectomy (RP)—alone or part as a multimodality approach—in patients with high-risk PCa, with satisfactory survival curves even though biochemical recurrence rate was high. Adjuvant treatment (radiotherapy (RT) alone or combined with androgen deprivation) was necessary in 20 to 54 % of patients, notably in cases with positive surgical margins. As for functional outcomes, urinary continence was preserved in about 92 % of cases and overall potency in 60 %. When comparing RP versus RT as primary treatment for high-risk PCa, a recent meta-analysis found surgery to be associated with an improved cancer-specific mortality compared with RT. In selected high-risk PCa young patients, surgery appears to be a valid option. Patients should however be informed of the possibility of adjuvant treatment, as part of a multimodal approach.

Keywords

Prostate cancer Radical prostatectomy High-risk Prostate cancer Radiotherapy Prognosis 

Die Rolle der Chirurgie bei Hochrisiko-Prostatakrebs

Zusammenfassung

Hochrisiko-Prostatakrebs ist ein sehr heterogenes Krankheitsbild. Neueste Serien haben vielversprechende Ergebnisse der alleinigen chirurgischen Behandlung, beziehungsweise der Chirurgie als Teil eines multimodalen Ansatzes bei Patienten mit Hochrisiko-Prostatakarzinom gezeigt. Die Überlebenskurven waren zufriedenstellend, obwohl die biochemischen Rezidivraten erhöhte Werte zeigten. In 20–54 % war eine adjuvante Behandlung (Strahlentherapie allein oder in Kombination mit androgener Deprivation) notwendig, vor allem in Fällen mit positiven operativen Absetzrändern. Bei den funktionellen Ergebnissen wurde Harnkontinenz in etwa 92 % der Fälle beobachtet, die Erektion blieb in 60 % erhalten.~ Eine aktuelle Meta-Analyse konnte beim Vergleich der radikalen Prostatektomie gegenüber Strahlentherapie als Primärbehandlung für Hochrisiko-Prostatakarzinom-Patienten eine verbesserte krebsspezifische Mortalität im Vergleich zur alleinigen Strahlentherapie zeigen. In gut ausgewählten jungen Hochrisiko-Prostatakarzinom-Patienten ist ein chirurgischer Eingriff eine gute Option. Die Patienten sollten jedoch über die Möglichkeit der adjuvanten Behandlung als Teil eines multimodalen Ansatzes informiert werden.

Schlüsselwörter

Prostatakrebs radikale Prostatektomie Hochrisiko-Prostatakrebs Strahlentherapie Prognose 

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Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Cécilia Lanchon
    • 1
  • Shahrokh F. Shariat
    • 2
  • Morgan Rouprêt
    • 1
    • 3
  1. 1.Academic Department of UrologyAP-HP, Hôpital Pitié-SalpétrièreParisFrance
  2. 2.Department of UrologyMedical University of ViennaViennaAustria
  3. 3.UPMC Univ Paris 06, GRC5, ONCOTYPE-UroInstitut Universitaire de CancérologieParisFrance

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