Expanding Role of Surgery in Management of High Risk Prostate Cancer

Patients with high risk prostate cancer (PCa) have an increased risk of PSA failure, need for secondary therapy, metastatic progression and death from their disease. Although, definition of high risk PCa is not uniform and associated with a variable prognosis, there is an increased interest in surgery for the treatment of high risk PCa. Reported clinical series have shown that radical prostatectomy (RP) has excellent long-term outcomes for the treatment of the high risk patients and 50% of them can be spared of secondary treatments like androgen deprivation therapy. Surgery is also effective in selected patients with lymph node positive disease as part of a multi-modality management. Also, accurate pathologic staging after surgery ensures the application of proper secondary treatments in a timely fashion. At present, the lack of randomized trials comparing the long-term outcomes of RP and radiotherapy in high risk PCa precludes a certain conclusion if surgery-based management strategy is better or not.