title: Radical prostatectomy for locally advanced and metastatic prostate cancer.
abstract: The management of advanced prostate cancer remains challenging. Traditionally, radical prostatectomy was discouraged in patients with locally advanced or node positive disease owing to the increased complication rate and treatment related morbidity. However, technical advances and refinements in surgical techniques have enabled the outcomes for patients with high risk prostate cancer to be improved. More recently, the concept of cytoreductive prostatectomy has been described where surgery (often Combined with an extended lymph node dissection) is performed in the setting of metastatic disease. Indirect evidence suggests an advantage using the cytoreductive approach. Hypothetical explanations for this observed benefit include decreased tumour burden, immune modulation, improved response to secondary treatment and avoidance of secondary complications attributable to local tumour growth. Nevertheless, prospective trials are required to investigate this further.
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust , UK.
authors.forename: R
authors.initials: R
authors.lastname: Veeratterapillay
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust , UK.
authors.forename: S S
authors.initials: SS
authors.lastname: Goonewardene
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust , UK.
authors.forename: J
authors.initials: J
authors.lastname: Barclay
authors.affiliation: North Bristol NHS Trust , UK.
authors.forename: R
authors.initials: R
authors.lastname: Persad
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust , UK.
authors.forename: C
authors.initials: C
authors.lastname: Bach
mesh_terms: D065426:Cytoreduction Surgical Procedures; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D009362:Neoplasm Metastasis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Cytoreductive surgery; Radical prostatectomy; Survival