Radical prostatectomy for locally advanced and high-risk prostate cancer: A systematic review of the literature

Context: The role of radical prostatectomy (RP) in high-risk prostate cancer (PCa) is increasing. Purpose: To review the existing literature and determine the value of RP in high-risk and locally advanced PCa. Documentary source: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from 01/2000 through 05/2016 according to the PRISMA guidelines. Selection of studies: Forty-two studies describing outcomes of RP among 52,546 patients with high-risk and locally advanced PCa. Results: Mortality was approximately 0–1% and Clavien ≥ 3 complications ranged from 1.8% to 12%. Biochemical recurrence-free and metastasis-free survival ranged from 40 to 94% and 90 to 96.1% at 5 years and from 27 to 68% and 64.4 to 85.1% at 10 years, respectively. Overall and cancer specific survival ranged from 55.2 to 98.6% and 89.8 to 100% at 5 years and from 58 to 84% and 65 to 96% at 10 years, respectively. The 12-mo continence rates ranged from 32% to 96.2% and the erectile function recovery ranged from 60% to 64%. Limits: Studies were heterogeneous especially regarding the definition of high-risk disease and the use of adjuvant treatments. Conclusions: The utilization of RP in high-risk and locally advanced PCa is increasing. Existing data support the advantages of RP in this group of patients. However, uniformity in definitions and indications are a prerequisite in order to establish its role as an important therapeutic arm in a multimodality management strategy.