Radical Prostatectomy for Locally Advanced Prostate Cancer: Current Status

Improvement of recurrence-free survival after radical prostatectomy for locally advanced prostate cancer in relation to the time of surgical intervention

“…Приоритетной и наиболее широко принятой тактикой лечения таких пациентов длительное время считалась комбинация лучевой терапии с андрогенной депривацией, однако имеющиеся удовлетворительные отдаленные результаты хирургического лечения местно-распространенного РПЖ позволяют прогно-зировать дальнейшее увеличение его роли как в режи-ме монотерапии, так и в качестве этапа мультимодаль-ной терапии [5]. Вселяют оптимизм и появляющиеся сравнительные исследования, указывающие на более высокую выживаемость больных РПЖ после РПЭ в сравнении с лучевой терапией [6].…”

Utility of preoperative 3 Tesla pelvic phased-array multiparametric magnetic resonance imaging in prediction of extracapsular extension and seminal vesicle invasion of prostate cancer and its impact on surgical margin status: Experience at a Canadian academic tertiary care centre

“…Imaging modalities, such as transrectal ultrasound (TRUS)-guided biopsy and computed tomography (CT) have assisted in determining the appropriate treatment for patients presenting with PCa. [1][2][3] Despite the utility of these tools, they are often limited in their ability to predict extracapsular extension (ECE) of PCa. 3 Data have shown that 27% of patients clinically diagnosed with ECE actually have locally confined disease on pathology, while 25-30% of patients diagnosed with organ-confined disease actually have ECE at final pathology.…”

Urotensin II Receptor on Preoperative Biopsy is Associated with Upstaging and Upgrading in Prostate Cancer

“…The highly heterogeneous prognosis of localized disease poses a great challenge for clinicians and investigators, since prognostic assessment is essential to assess the balance of benefits and harms of treatment [2][3][4][5]. While a subset of patients can be safely actively monitored avoiding sexual, urinary and bowel toxicity associated with local treatments [2], patients with aggressive disease require a multimodality approach that includes surgery [3] and/or radiation therapy plus adjuvant hormonal treatment [4]. The clinical stage, prostate-specific antigen (PSA) levels and the biopsy Gleason score have been incorporated in an extensively employed risk classification model originally …”

“…Apart from these variables, which have been incorporated in a validated predictive model to predict Gleason upgrading [11], a number of biomolecular markers were associated with Gleason upgrading [12,13]. Upgrading and upstaging have important therapeutic implications, as biopsy Gleason score and clinical stage along with PSA levels are the mainstay of the treatment-decision algorithm for localized prostate cancer [2][3][4][5]. Notably, baseline radiographic clinical staging has serious limitations.…”

“…Furthermore, in patients undergoing radiotherapy, biopsy Gleason score is essential for optimal dosing and duration of androgen deprivation treatment [4]. Finally, patients with clinical T2 disease but pathologic T3 disease who undergo radical prostatectomy also have to receive subsequent radiotherapy in addition to surgery, with increased morbidity and decreased quality of life [3]. The importance of upstaging and upgrading is also underlined by their independent prognostic value.…”