Radical Prostatectomy is a Valuable Treatment Alternative in Patients with High-Risk Prostate Cancer

Objective\udTo review the high-risk prostate cancer (PCa) patient database with special emphasis on the role of radical prostatectomy (RP) in comparison to external beam radiotherapy (EBRT).\udMaterials and Methods\udA total of 102 patients with complete and long-term follow-up data were included. High-risk PCa was defined as: a pre-treatment PSA level of ≥20 ng/mL and/or a primary Gleason score of ≥4 and/or clinical stage ≥T3N0M0 disease. A total of 45 (42.5%) patients underwent radical RP with extended pelvic lymphadenectomy for-high risk PCa and a total of 57 (53.8%) patients received EBRT.\udResults\udThe mean overall survival (mean survival 95.2 vs. 129.2 months, log rank p=0.73) and cancer-specific survival (mean survival 104 vs. 151.4 months, log rank p=0.35) were not significantly different between RP and EBRT groups. Univariate analysis of variables that may affect overall survival showed no significant effect of pre-treatment PSA, Gleason score, clinical stage or type of therapy. The only factor which reached statistical significance was patient age (p=0.002). Multivariate analysis of variables also showed no significant effect of pre-treatment PSA, Gleason score, clinical stage or type of therapy and, again, the only factor which reached statistical significance was patient age (p=0.012).\udConclusion\udRadical prostatectomy appears to be an effective and a non-inferior treatment option in patients with high-risk localized PCa with acceptable overall and cancer-specific survival compared to RT. Therefore, as the guidelines suggest, it should be provided as an option during patient consultation for a proper informed decision-making