Radical prostatectomy in locally advanced and metastatic prostate cancer

BackgroundThe proportion of patients with locally advanced or (oligo)metastatic prostate cancer (PCa) is increasing. Compared to patients with localized PCa, without local therapy the risk of local complications is higher and the oncological outcome is worse.ObjectiveTo analyze the impact of radical prostatectomy (RP) in patients with locally advanced or metastatic PCa.Material and methodsAreview of the literature was performed using PubMed and Medline databases focusing on articles addressing locally advanced and metastatic PCa.ResultsCurrent guidelines recommend RP as one of the treatment options in patients with locally advanced PCa. In contrast, an RP in patients with metastatic PCa should only be performed within clinical trials. Compared to patients without local treatment, RP clearly decreases the risk of local complications. While an oncological benefit could be shown for RP in locally advanced PCa, the benefit in patients with metastatic disease is still amatter of debate. Due to more challenging surgical conditions and an increased probability for a multimodal treatment concept, higher perioperative morbidity and worse functional outcomes compared to patients with localized PCa are reported in the literature.ConclusionWhile RP should be offered to patients with locally advanced PCa under the same conditions as for localized PCa, its benefit in metastatic disease needs further clarification. All patients undergoing RP need to be counselled especially about the possibly worse postoperative functional outcome.