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

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Abstract

Controversy remains regarding the preferred therapy for high-risk, clinically localized prostate cancer. High-risk prostate cancer represents a diverse disease entity for which accurate risk assessment is critical to informed counseling and clinical decision making. For men with high-risk features, electing surgery as a local definitive therapy should be based on the best available evidence rather than a surgeon’s bias and experience. Patients classified with high-risk prostate cancer by common definitions do not have a uniformly poor prognosis after radical prostatectomy. Many cancers that are clinically categorized as high risk are actually pathologically confined to the prostate, and most of these men do not require additional long-term therapy after surgery. For some high-risk patients, an integrated approach combining local and systemic therapy may be advantageous. Available studies using adjuvant and neoadjuvant strategies have their individual strengths and weaknesses; unfortunately, none has provided persuasive evidence to dictate the standard of care in the high-risk setting. Therefore, results are eagerly anticipated from ongoing randomized trials exploring the merits of perioperative chemohormonal therapy in high-risk patients. This review discusses current limitations and challenges in accurately identifying high-risk patients and focuses on radical prostatectomy alone or as part of multimodal therapy for men with high-risk prostate cancer.

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References and Recommended Reading

  1. Thompson I, Thrasher JB, Aus G, et al.: Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007, 177:2106–2131.

    Article  PubMed  Google Scholar 

  2. Kane CJ, Presti JC Jr, Amling CL, et al.: Changing nature of high risk patients undergoing radical prostatectomy. J Urol 2007, 177:113–117.

    Article  PubMed  Google Scholar 

  3. Meng MV, Elkin EP, Latini DM, et al.: Treatment of patients with high risk localized prostate cancer: results from cancer of the prostate strategic urological research endeavor (CaPSURE). J Urol 2005, 173:1557–1561.

    Article  PubMed  Google Scholar 

  4. Denberg TD, Glode LM, Steiner JF, et al.: Trends and predictors of aggressive therapy for clinical locally advanced prostate carcinoma. BJU Int 2006, 98:335–340.

    Article  PubMed  Google Scholar 

  5. Cooperberg MR, Moul JW, Carroll PR: The changing face of prostate cancer. J Clin Oncol 2005, 23:8146–8151.

    Article  PubMed  Google Scholar 

  6. Gerber GS, Thisted RA, Chodak GW, et al.: Results of radical prostatectomy in men with locally advanced prostate cancer: multi-institutional pooled analysis. Eur Urol 1997, 32:385–390.

    PubMed  CAS  Google Scholar 

  7. Clark PE, Peereboom DM, Dreicer R, et al.: Phase II trial of neoadjuvant estramustine and etoposide plus radical prostatectomy for locally advanced prostate cancer. Urology 2001, 57:281–285.

    Article  PubMed  CAS  Google Scholar 

  8. Dreicer R, Magi-Galluzzi C, Zhou M, et al.: Phase II trial of neoadjuvant docetaxel before radical prostatectomy for locally advanced prostate cancer. Urology 2004, 63:1138–1142.

    Article  PubMed  Google Scholar 

  9. Donohue JF, Bianco FJ, Jr., Kuroiwa K, et al.: Poorly differentiated prostate cancer treated with radical prostatectomy: long-term outcome and incidence of pathological downgrading. J Urol 2006, 176:991–995.

    Article  PubMed  Google Scholar 

  10. Lau WK, Bergstralh EJ, Blute ML, et al.: Radical prostatectomy for pathological Gleason 8 or greater prostate cancer: influence of concomitant pathological variables. J Urol 2002, 167:117–122.

    Article  PubMed  Google Scholar 

  11. Ward JF, Slezak JM, Blute ML, et al.: Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int 2005, 95:751–756.

    Article  PubMed  Google Scholar 

  12. Grossfeld GD, Chang JJ, Broering JM, et al.: Under staging and under grading in a contemporary series of patients undergoing radical prostatectomy: results from the Cancer of the Prostate Strategic Urologic Research Endeavor database. J Urol 2001, 165:851–856.

    Article  PubMed  CAS  Google Scholar 

  13. Eastham JA, Riedel E, Scardino PT, et al.: Variation of serum prostate-specific antigen levels: an evaluation of year-to-year fluctuations. JAMA 2003, 289:2695–2700.

    Article  PubMed  CAS  Google Scholar 

  14. D’Amico AV, Whittington R, Malkowicz SB, et al.: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998, 280:969–974.

    Article  PubMed  CAS  Google Scholar 

  15. Shahinian VB, Kuo YF, Freeman JL, Goodwin JS: Determinants of androgen deprivation therapy use for prostate cancer: role of the urologist. J Natl Cancer Inst 2006, 98:839–845.

    PubMed  Google Scholar 

  16. Tsai HK, Chen MH, McLeod DG, et al.: Cancer-specific mortality after radiation therapy with short-course hormonal therapy or radical prostatectomy in men with localized, intermediate-risk to high-risk prostate cancer. Cancer 2006, 107:2597–2603.

    Article  PubMed  CAS  Google Scholar 

  17. Stephenson AJ, Scardino PT, Eastham JA, et al.: Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst 2006, 98:715–717.

    Article  PubMed  Google Scholar 

  18. D’Amico AV, Chen MH, Roehl KA, Catalona WJ: Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004, 351:125–135.

    Article  PubMed  CAS  Google Scholar 

  19. D’Amico AV, Chen MH, Catalona WJ, et al.: Prostate cancer-specific mortality after radical prostatectomy or external beam radiation therapy in men with 1 or more high-risk factors. Cancer 2007, 110:56–61.

    Article  PubMed  Google Scholar 

  20. Bianco FJ Jr, Kattan MW, Scardino PT: PSA velocity and prostate cancer. N Engl J Med 2004, 351:1800–1802; author reply 1800–1802.

    Article  PubMed  CAS  Google Scholar 

  21. Yossepowitch O, Eggener SE, Bianco FJ Jr, et al.: Radical prostatectomy for clinically localized, high risk prostate cancer: critical analysis of risk assessment methods. J Urol 2007, 178:493–499; discussion 499.

    Article  PubMed  Google Scholar 

  22. Stephenson AJ, Scardino PT, Eastham JA, et al.: Pretreatment nomogram predicting the long-term risk of metastatic progression of prostate cancer after radical prostatectomy. J Clin Oncol 2005, 23:4545.

    Article  CAS  Google Scholar 

  23. van den Ouden D, Hop WC, Schroder FH: Progression in and survival of patients with locally advanced prostate cancer (T3) treated with radical prostatectomy as monotherapy. J Urol 1998, 160:1392–1397.

    Article  PubMed  Google Scholar 

  24. Hsu CY, Joniau S, Oyen R, et al.: Outcome of surgery for clinical unilateral T3a prostate cancer: a single-institution experience. Eur Urol 2007, 51:121–128; discussion 128–129.

    Article  PubMed  Google Scholar 

  25. Berglund RK, Jones JS, Ulchaker JC, et al.: Radical prostatectomy as primary treatment modality for locally advanced prostate cancer: a prospective analysis. Urology 2006, 67:1253–1256.

    Article  PubMed  Google Scholar 

  26. 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, 69:1170–1175.

    Article  PubMed  Google Scholar 

  27. 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 2007.

  28. Van Poppel H, Vekemans K, Da Pozzo L, et al.: Radical prostatectomy for locally advanced prostate cancer: results of a feasibility study (EORTC 30001). Eur J Cancer 2006, 42:1062–1067.

    Article  PubMed  Google Scholar 

  29. Gontero P, Marchioro G, Pisani R, et al.: Is radical prostatectomy feasible in all cases of locally advanced non-bone metastatic prostate cancer? Results of a single-institution study. Eur Urol 2007, 51:922–929; discussion 929–930.

    Article  PubMed  Google Scholar 

  30. D’Amico AV, Manola J, Loffredo M, et al.: 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA 2004, 292:821–827.

    Article  PubMed  CAS  Google Scholar 

  31. Bolla M, Collette L, Blank L, et al.: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 2002, 360:103–106.

    Article  PubMed  CAS  Google Scholar 

  32. Labrie F, Cusan L, Gomez JL, et al.: Neoadjuvant hormonal therapy: the Canadian experience. Urology 1997, 49:56–64.

    Article  PubMed  CAS  Google Scholar 

  33. Schulman CC, Debruyne FM, Forster G, et al.: 4-Year follow-up results of a European prospective randomized study on neoadjuvant hormonal therapy prior to radical prostatectomy in T2-3N0M0 prostate cancer. European Study Group on Neoadjuvant Treatment of Prostate Cancer. Eur Urol 2000, 38:706–713.

    Article  PubMed  CAS  Google Scholar 

  34. Klotz LH, Goldenberg SL, Jewett MA, et al.: Long-term followup of a randomized trial of 0 versus 3 months of neoadjuvant androgen ablation before radical prostatectomy. J Urol 2003, 170:791–794.

    Article  PubMed  CAS  Google Scholar 

  35. Soloway MS, Pareek K, Sharifi R, et al.: Neoadjuvant androgen ablation before radical prostatectomy in cT2bNxMo prostate cancer: 5-year results. J Urol 2002, 167:112–116.

    Article  PubMed  Google Scholar 

  36. Aus G, Abrahamsson PA, Ahlgren G, et al.: Three-month neoadjuvant hormonal therapy before radical prostatectomy: a 7-year follow-up of a randomized controlled trial. BJU Int 2002, 90:561–566.

    Article  PubMed  CAS  Google Scholar 

  37. Gleave ME, Goldenberg SL, Chin JL, et al.: Randomized comparative study of 3 versus 8-month neoadjuvant hormonal therapy before radical prostatectomy: biochemical and pathological effects. J Urol 2001, 166:500–506; discussion 506–507.

    Article  PubMed  CAS  Google Scholar 

  38. Gleave ME, Goldenberg SL, Jewett MA, et al.: Randomized comparative study of 3 vs 8 months of neoadjuvant hormonal therapy prior to radical prostatectomy: 3 year PSA recurrence rates. Proceedings of the American Urological Association Annual Meeting. Chicago, IL; April 26–May 1, 2003.

  39. Konety BR, Eastham JA, Reuter VE, et al.: Feasibility of radical prostatectomy after neoadjuvant chemohormonal therapy for patients with high risk or locally advanced prostate cancer: results of a phase I/II study. J Urol 2004, 171:709–713.

    Article  PubMed  Google Scholar 

  40. Pettaway CA, Pisters LL, Troncoso P, et al.: Neoadjuvant chemotherapy and hormonal therapy followed by radical prostatectomy: feasibility and preliminary results. J Clin Oncol 2000, 18:1050–1057.

    PubMed  CAS  Google Scholar 

  41. Febbo PG, Richie JP, George DJ, et al.: Neoadjuvant docetaxel before radical prostatectomy in patients with high-risk localized prostate cancer. Clin Cancer Res 2005, 11:5233–5240.

    Article  PubMed  CAS  Google Scholar 

  42. Kattan MW, Eastham JA, Stapleton AM, et al.: A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst 1998, 90:766–771.

    Article  PubMed  CAS  Google Scholar 

  43. Thompson IM Jr, Tangen CM, Paradelo J, et al.: Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA 2006, 296:2329–2335.

    Article  PubMed  CAS  Google Scholar 

  44. Bolla M, van Poppel H, Collette L, et al.: Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 2005, 366:572–578.

    Article  PubMed  Google Scholar 

  45. Van der Kwast TH, Bolla M, Van Poppel H, et al.: Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911. J Clin Oncol 2007, 25:4178–4186.

    Article  PubMed  Google Scholar 

  46. Messing EM, Manola J, Yao J, et al.: Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 2006, 7:472–479.

    Article  PubMed  CAS  Google Scholar 

  47. Wirth M, Tyrrell C, Delaere K, et al.: Bicalutamide (Casodex) 150 mg plus standard care in early non-metastatic prostate cancer: results from Early Prostate Cancer Trial 24 at a median 7 years’ follow-up. Prostate Cancer Prostatic Dis 2007, 10:87–93.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA

    James A. Eastham

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  1. Ofer Yossepowitch
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  2. James A. Eastham
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Correspondence to James A. Eastham.

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Yossepowitch, O., Eastham, J.A. Role of radical prostatectomy in the treatment of high-risk prostate cancer. Curr Urol Rep 9, 203–210 (2008). https://doi.org/10.1007/s11934-008-0036-x

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