title: Role of Surgery in locally advanced prostate cancer.
abstract: A significant proportion of patients present with locally advanced prostate cancer with inherent higher risk of local recurrence and systemic relapse after initial treatment. Recent literature favors combination of radiation therapy and extended hormonal therapy for this subset of patients. The effectiveness of Radical prostatectomy (RP) alone for locally advanced prostate cancer is controversial and is a focus of debate. However, it can decrease the tumor burden and allows the accurate and precise pathological staging with the need for subsequent treatment. Comparison of RP and other treatment modalities is difficult and incorrect because of inherent selection bias. RP as a part of multi-modality treatment (with neo-adjuvant hormonal therapy (HT) and with adjuvant or salvage radiation therapy (RT)/HT) can provide long term overall and cancer specific survival. Surgical treatment (such as transurethral resection (TUR), JJ stenting and percutaneous nephrostomy (PCN) placement etc.) can also provide symptomatic improvement and palliative care to improve quality of life of patients with advanced prostate cancer.
  The articles published between years 1998-2014 were searched on electronic databases Pubmed, Science direct, Google scholar and Embase and used for preparation of this review.
authors.affiliation: Syed Muhammad Nazim, Section of Urology, Department of surgery, The Aga Khan University, Karachi Pakistan.
authors.forename: Syed Muhammad
authors.initials: SM
authors.lastname: Nazim
authors.affiliation: Farhat Abbas, Section of Urology, Department of surgery, The Aga Khan University, Karachi Pakistan.
authors.forename: Farhat
authors.initials: F
authors.lastname: Abbas
keywords: Locally advanced; Prostate cancer; Radical prostatectomy; Surgery