Radical prostatectomy for locally advanced and high-risk prostate cancer: A systematic review of the literature

Prog Urol. 2018 Dec;28(16):875-889. doi: 10.1016/j.purol.2018.08.007. Epub 2018 Sep 24.

Abstract

Context: The role of radical prostatectomy (RP) in high-risk prostate cancer (PCa) is increasing.

Purpose: To review the existing literature and determine the value of RP in high-risk and locally advanced PCa.

Documentary source: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from 01/2000 through 05/2016 according to the PRISMA guidelines.

Selection of studies: Forty-two studies describing outcomes of RP among 52,546 patients with high-risk and locally advanced PCa.

Results: Mortality was approximately 0-1% and Clavien≥3 complications ranged from 1.8% to 12%. Biochemical recurrence-free and metastasis-free survival ranged from 40 to 94% and 90 to 96.1% at 5 years and from 27 to 68% and 64.4 to 85.1% at 10 years, respectively. Overall and cancer specific survival ranged from 55.2 to 98.6% and 89.8 to 100% at 5 years and from 58 to 84% and 65 to 96% at 10 years, respectively. The 12-mo continence rates ranged from 32% to 96.2% and the erectile function recovery ranged from 60% to 64%.

Limits: Studies were heterogeneous especially regarding the definition of high-risk disease and the use of adjuvant treatments.

Conclusions: The utilization of RP in high-risk and locally advanced PCa is increasing. Existing data support the advantages of RP in this group of patients. However, uniformity in definitions and indications are a prerequisite in order to establish its role as an important therapeutic arm in a multimodality management strategy.

Keywords: Cancer de prostate; Haut risque; High-risk; Oncologic outcomes; Prostate cancer; Prostatectomie; Radical prostatectomy; Résultats oncologiques; Survie; Survival.

Publication types

  • Systematic Review

MeSH terms

  • Combined Modality Therapy / methods
  • Disease Progression
  • Humans
  • Male
  • Neoplasm Invasiveness
  • Prostatectomy / methods*
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / pathology*
  • Prostatic Neoplasms / surgery*
  • Risk Factors
  • Survival Analysis