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The role for surgeryin high-risk prostate cancer

Die Rolle der Chirurgie bei Hochrisiko-Prostatakrebs

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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.

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.

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Authors and Affiliations

  1. Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, 83 Bvd Hôpital, 75013, Paris, France

    Cécilia Lanchon & Morgan Rouprêt MD, PhD

  2. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  3. UPMC Univ Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, 75005, Paris, France

    Morgan Rouprêt MD, PhD

Authors
  1. Cécilia Lanchon
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  2. Shahrokh F. Shariat
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  3. Morgan Rouprêt MD, PhD
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Correspondence to Morgan Rouprêt MD, PhD.

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Lanchon, C., F. Shariat, S. & Rouprêt, M. The role for surgeryin high-risk prostate cancer. Wien Med Wochenschr 165, 395–400 (2015). https://doi.org/10.1007/s10354-015-0389-y

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  • DOI: https://doi.org/10.1007/s10354-015-0389-y

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