title: Results of surgery for high-risk prostate cancer.
abstract: OBJECTIVE
  Surgery for high-risk prostate cancer (PCa) is applied frequently nowadays. Nevertheless, this approach is still surrounded by many controversies. The present review discusses the most recent literature regarding surgery for high-risk PCa.
  
  
  RESULTS
  As there is no standard definition of high-risk PCa, outcome comparison between series and treatment approaches is hampered. Nevertheless, recent radical prostatectomy series have shown excellent cancer-specific survival in patients with high-risk PCa. Even for very-high-risk PCa (cT3b-T4 or any cT, N1), surgery may be applied to highly selected patients as a first step of a multimodality approach. Recent experience with robot-assisted surgery opens new possibilities for a minimally invasive approach in this field.Patient selection for surgery was also addressed in recent studies. Excellent cancer-specific survival is seen when specimen-confined PCa is found at final histopathology; a recently published nomogram enables the prediction of specimen-confined disease. Another issue in high-risk PCa is the impact of age and comorbidities on cancer-specific and overall mortality. In a recent study, it was shown that patients with low comorbidity scores, even when at least 70 years old, had a significant risk of dying from their cancer and may benefit most from a surgical approach. A modified extended pelvic lymphadenectomy template was presented, providing optimal removal of positive lymph nodes.
  
  
  CONCLUSIONS
  Radical prostatectomy with extended pelvic lymphadenectomy delivers very good cancer-related outcomes in high-risk and very-high-risk PCa, often within a multimodal approach. Minimally invasive surgery and improved patient selection will be key to further improve oncological and functional outcomes.
authors.affiliation: Urology, Department of Development and Regeneration, University Hospital of Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Tosco
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Thomas
authors.initials: T
authors.lastname: Vanden Broeck
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.forename: Martin
authors.initials: M
authors.lastname: Spahn
authors.forename: Hein
authors.initials: H
authors.lastname: Van Poppel
mesh_terms: D000367:Age Factors; D000368:Aged; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000009:adverse effects / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome