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The role for surgeryin high-risk prostate cancer

Die Rolle der Chirurgie bei Hochrisiko-Prostatakrebs

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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.


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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  1. Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65(1):124–37.

    Article  PubMed  Google Scholar 

  2. Heidenreich A, Bastian PJ, Bellmunt J, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65(2):467–79.

    Article  CAS  PubMed  Google Scholar 

  3. Salomon L, Bastide C, Beuzeboc P, et al. [CCAFU recommendations 2013: prostate cancer]. Prog Urol. 2013;23 Suppl 2:69–101.

    Article  Google Scholar 

  4. Yossepowitch O, Eggener SE, Serio AM, et al. Secondary therapy, metastatic progression, and cancer-specific mortality in men with clinically high-risk prostate cancer treated with radical prostatectomy. Eur Urol. 2008;53(5):950–9.

    Article  PubMed Central  PubMed  Google Scholar 

  5. D’Amico AV, Desjardin A, Chung A, et al. Assessment of outcome prediction models for patients with localized prostate carcinoma managed with radical prostatectomy or external beam radiation therapy. Cancer. 1998;82(10):1887–96.

    Article  PubMed  Google Scholar 

  6. Mohler J, Bahnson RR, Boston B, et al. NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw. 2010;8(2):162–200.

    CAS  PubMed  Google Scholar 

  7. Algarra R, Zudaire B, Tienza A, et al. Optimizing D’Amico risk groups in radical prostatectomy through the addition of magnetic resonance imaging data. Actas Urol Esp. 2014;38(9):594–9.

    Article  CAS  PubMed  Google Scholar 

  8. Thompson J, Lawrentschuk N, Frydenberg M, Thompson L, Stricker P. The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int. 2013;112 Suppl 2:6–20.

    Article  PubMed  Google Scholar 

  9. Renard-Penna R, Roupret M, Comperat E, et al. Accuracy of high resolution (1.5 T) pelvic phased array magnetic resonance imaging (MRI) in staging prostate cancer in candidates for radical prostatectomy: results from a prospective study. Urol Oncol. 2013;31(4):448–54.

    Article  PubMed  Google Scholar 

  10. Briganti A, Chun FK, Salonia A, et al. A nomogram for staging of exclusive nonobturator lymph node metastases in men with localized prostate cancer. Eur Urol. 2007;51(1):112–9. (discussion 119–120).

    Article  PubMed  Google Scholar 

  11. Mearini L, Nunzi E, Bini V, Lepri L, Bruno R, Porena M. Radical prostatectomy in high-risk prostate cancer: incidence of specimen-confined disease (pT2-pT3a N0R0) and outcomes. Urologia. 2014;81(2):125–32.

    Article  PubMed  Google Scholar 

  12. Roumiguie M, Beauval JB, Filleron T, et al. External validation of the Briganti nomogram to estimate the probability of specimen confined disease in patients with high-risk prostate cancer. BJU Int. 2014;114(6b):E113–9.

    Article  CAS  PubMed  Google Scholar 

  13. Loeb S, Smith ND, Roehl KA, Catalona WJ. Intermediate-term potency, continence, and survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer. Urology. 2007;69(6):1170–5.

    Article  PubMed  Google Scholar 

  14. Hsu CY, Joniau S, Oyen R, Roskams T, Van Poppel H. Outcome of surgery for clinical unilateral T3a prostate cancer: a single-institution experience. Eur Urol. 2007;51(1):121–8. (discussion 128–9).

    Article  PubMed  Google Scholar 

  15. Ploussard G, Salomon L, Allory Y, et al. Pathological findings and prostate-specific antigen outcomes after laparoscopic radical prostatectomy for high-risk prostate cancer. BJU Int. 2010;106(1):86–90.

    Article  PubMed  Google Scholar 

  16. Yamamoto S, Kawakami S, Yonese J, et al. Long-term oncological outcome and risk stratification in men with high-risk prostate cancer treated with radical prostatectomy. Jpn J Clin Oncol. 2012;42(6):541–7.

    Article  PubMed  Google Scholar 

  17. Nguyen K, Eltz S, Drouin SJ, et al. Oncologic outcome after radical prostatectomy in men with PSA values above 20 ng/ml: a monocentric experience. World J Urol. 2009;27(5):653–8.

    Article  PubMed  Google Scholar 

  18. Spahn M, Joniau S, Gontero P, et al. Outcome predictors of radical prostatectomy in patients with prostate-specific antigen greater than 20 ng/ml: a European multi-institutional study of 712 patients. Eur Urol. 2010;58(1):1–7. (discussion 10–11).

    Article  PubMed  Google Scholar 

  19. Pokala N, Trulson JJ, Islam M. Long-term outcome following radical prostatectomy for Gleason 8–10 prostatic adenocarcinoma. World J Urol. 2014;32(6):1385–92.

    Article  PubMed  Google Scholar 

  20. Eggener SE, Scardino PT, Walsh PC, et al. Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol. 2011;185(3):869–75.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Bolla M, van Poppel H, Collette L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet. 2005;366(9485):572–8.

    Article  PubMed  Google Scholar 

  22. Thompson IM Jr, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA. 2006;296(19):2329–35.

    Article  CAS  PubMed  Google Scholar 

  23. Murphy DG, Kerger M, Crowe H, Peters JS, Costello AJ. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol. 2009;55(6):1358–66.

    Article  PubMed  Google Scholar 

  24. Petrelli F, Vavassori I, Coinu A, Borgonovo K, Sarti E, Barni S. Radical prostatectomy or radiotherapy in high-risk prostate cancer: a systematic review and metaanalysis. Clin Genitourin Cancer. 2014;12(4):215–24.

    Article  PubMed  Google Scholar 

  25. Abdollah F, Schmitges J, Sun M, et al. Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: a population-based analysis. Int J Urol. 2012;19(9):836–44. (author reply 844–835).

    Article  PubMed  Google Scholar 

  26. Arcangeli G, Strigari L, Arcangeli S, et al. Retrospective comparison of external beam radiotherapy and radical prostatectomy in high-risk, clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2009;75(4):975–82.

    Article  PubMed  Google Scholar 

  27. Shao YH, Kim S, Moore DF, et al. Cancer-specific survival after metastasis following primary radical prostatectomy compared with radiation therapy in prostate cancer patients: results of a population-based, propensity score-matched analysis. Eur Urol. 2014;65(4):693–700.

    Article  PubMed  Google Scholar 

  28. Boorjian SA, Karnes RJ, Viterbo R, et al. Long-term survival after radical prostatectomy versus external-beam radiotherapy for patients with high-risk prostate cancer. Cancer. 2011;117(13):2883–91.

    Article  PubMed Central  PubMed  Google Scholar 

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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).

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