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Japanese Journal of Clinical Oncology Advance Access published online on October 19, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp130
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© The Author (2009). Published by Oxford University Press. All rights reserved

Radical Prostatectomy for High-risk Prostate Cancer*

R. Jeffrey Karnes1, Tadashi Hatano2, Michael L. Blute1 and Robert P. Myers1

1 Department of Urology, Mayo Clinic, Rochester, MN, USA
2 Department of Urology, Tokyo Medical University, Tokyo, Japan

For reprints and all correspondence: Robert P. Myers, Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. E-mail: myers.robert{at}mayo.edu

Received April 22, 2009; accepted September 3, 2009

The prostate-specific antigen (PSA) era has changed the pattern of prostate cancer at presentation. Patients now present with lower-stage, lower-risk disease. However, some patients continue to present with high-risk prostate cancer (high-risk PC), and the effect of PSA introduction on outcome is less clear. This review highlights the salient features of why radical prostatectomy should be considered in the management of men with high-risk PC (Gleason score 8–10, marked increase in PSA levels and advanced clinical T stage). Radical retropubic prostatectomy (RRP) can provide durable local control, long-term cancer-specific survival and accurate pathologic staging, and may guide further individualized treatment. For these reasons, RRP remains the best single treatment of high-risk PC in operable patients.

Key Words: prostatectomy • prostate-specific antigen • prostatic neoplasms

* Presented in part at the 58th Japanese Urological Association—Central Section Meeting, Otsu, Japan, 15 November 2008.


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