Radical prostatectomy in locally advanced prostate cancer

Abstract

Although in the prostate-specific antigen (PSA) era most of patients are diagnosed with a low-risk localized prostate cancer (PCa), still 10-30% of the screened men will have a locally advanced disease (clinical stage (cT)=3a) at presentation (Lowrance et al., BJU Int 109:1309-1314, 2012; Gözen et al., BJU Int 116:102-108, 2015). Considering the well-documented high risk of recurrence, these patients were historically ideal candidates for systemic therapies (Lowrance et al., BJU Int 109:1309-1314, 2012). Although a consensus regarding the best treatment option for these patients is still missing, most of them will undergo radiation combined with androgen deprivation therapy (ADT) (Widmark et al., Lancet 373:301-308, 2009; Roach et al., J Clin Oncol 26:585-591, 2008; Bolla et al., Lancet 360:103-106, 2002). However, it has been proven that patients harboring high-risk/locally-advanced PCa are those who will more likely benefit from active treatment. Their risk of recurrence and cancer-specific mortality (CSM), in fact, is the highest immediately after surgery but it substantially decreases over time, highlighting the curative efficacy of local treatment (Briganti et al., Urol Oncol 33:163.e7-e13, 2015).