Results of surgery for high-risk prostate cancer

Steven Joniau, Lorenzo Tosco, Alberto Briganti, Thomas Vanden Broeck, Paolo Gontero, Robert Jeffrey Karnes, Martin Spahn, Hein Van Poppel

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: Surgery for high-risk prostate cancer (PCa) is applied frequently nowadays. Nevertheless, this approach is still surrounded by many controversies. The present review discusses the most recent literature regarding surgery for high-risk PCa. RECENT FINDINGS: As there is no standard definition of high-risk PCa, outcome comparison between series and treatment approaches is hampered. Nevertheless, recent radical prostatectomy series have shown excellent cancer-specific survival in patients with high-risk PCa. Even for very-high-risk PCa (cT3b-T4 or any cT, N1), surgery may be applied to highly selected patients as a first step of a multimodality approach. Recent experience with robot-assisted surgery opens new possibilities for a minimally invasive approach in this field.Patient selection for surgery was also addressed in recent studies. Excellent cancer-specific survival is seen when specimen-confined PCa is found at final histopathology; a recently published nomogram enables the prediction of specimen-confined disease. Another issue in high-risk PCa is the impact of age and comorbidities on cancer-specific and overall mortality. In a recent study, it was shown that patients with low comorbidity scores, even when at least 70 years old, had a significant risk of dying from their cancer and may benefit most from a surgical approach. A modified extended pelvic lymphadenectomy template was presented, providing optimal removal of positive lymph nodes. SUMMARY: Radical prostatectomy with extended pelvic lymphadenectomy delivers very good cancer-related outcomes in high-risk and very-high-risk PCa, often within a multimodal approach. Minimally invasive surgery and improved patient selection will be key to further improve oncological and functional outcomes.

Original languageEnglish (US)
Pages (from-to)342-348
Number of pages7
JournalCurrent Opinion in Urology
Volume23
Issue number4
DOIs
StatePublished - Jul 2013

Fingerprint

Prostatic Neoplasms
Neoplasms
Prostatectomy
Lymph Node Excision
Patient Selection
Comorbidity
Nomograms
Minimally Invasive Surgical Procedures
Survival
Lymph Nodes
Mortality

Keywords

  • cancer-specific survival
  • high-risk prostate cancer
  • surgery

ASJC Scopus subject areas

  • Urology

Cite this

Joniau, S., Tosco, L., Briganti, A., Vanden Broeck, T., Gontero, P., Karnes, R. J., ... Van Poppel, H. (2013). Results of surgery for high-risk prostate cancer. Current Opinion in Urology, 23(4), 342-348. https://doi.org/10.1097/MOU.0b013e3283620f60

Results of surgery for high-risk prostate cancer. / Joniau, Steven; Tosco, Lorenzo; Briganti, Alberto; Vanden Broeck, Thomas; Gontero, Paolo; Karnes, Robert Jeffrey; Spahn, Martin; Van Poppel, Hein.

In: Current Opinion in Urology, Vol. 23, No. 4, 07.2013, p. 342-348.

Research output: Contribution to journalArticle

Joniau, S, Tosco, L, Briganti, A, Vanden Broeck, T, Gontero, P, Karnes, RJ, Spahn, M & Van Poppel, H 2013, 'Results of surgery for high-risk prostate cancer', Current Opinion in Urology, vol. 23, no. 4, pp. 342-348. https://doi.org/10.1097/MOU.0b013e3283620f60
Joniau S, Tosco L, Briganti A, Vanden Broeck T, Gontero P, Karnes RJ et al. Results of surgery for high-risk prostate cancer. Current Opinion in Urology. 2013 Jul;23(4):342-348. https://doi.org/10.1097/MOU.0b013e3283620f60
Joniau, Steven ; Tosco, Lorenzo ; Briganti, Alberto ; Vanden Broeck, Thomas ; Gontero, Paolo ; Karnes, Robert Jeffrey ; Spahn, Martin ; Van Poppel, Hein. / Results of surgery for high-risk prostate cancer. In: Current Opinion in Urology. 2013 ; Vol. 23, No. 4. pp. 342-348.
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