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Radical Prostatectomy in the Metastatic Setting

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Prostate Cancer

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Abstract

Multiple studies as outlined before have demonstrated a benefit of RP over ADT alone in the N1M0 setting. Thus, we would not hesitate to offer a patient radical prostatectomy with an extended PLND (including removal of the low retroperitoneal nodes in some cases) if he is healthy and interested in an aggressive approach. Preoperative counseling would be extensive, and we would emphasize that there is a high chance of a multimodal approach. Postoperative ADT will often be advocated if the number of positive nodes is three or more or if he has pT3b and one or two nodes positive. Postoperative radiotherapy to the fossa and whole pelvis will also often be delivered (again depending on the patient’s risk) when the patient has regained continence and is usually given in conjunction with ADT. Lastly, we would risk stratify his disease postoperatively and have him understand his overall prognosis based on our models detailed in this chapter.

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Matteo Soligo M.D., Vidit Sharma M.D. & R. Jeffrey Karnes M.D., F.A.C.S.

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  1. Matteo Soligo M.D.
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  2. Vidit Sharma M.D.
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  3. R. Jeffrey Karnes M.D., F.A.C.S.
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Correspondence to R. Jeffrey Karnes M.D., F.A.C.S. .

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Editors and Affiliations

  1. Department of Urologic Surgery and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Sam S. Chang

  2. Department of Urology, University of Oklahoma Medical Center, Oklahoma City, Oklahoma, USA

    Michael S. Cookson

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Soligo, M., Sharma, V., Jeffrey Karnes, R. (2018). Radical Prostatectomy in the Metastatic Setting. In: Chang, S., Cookson, M. (eds) Prostate Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-78646-9_12

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