Operative therapy of localized prostate cancer

Radical prostatectomy is the most frequently used therapy for localized prostate cancer. Staging measures are based on the preoperative parameters prostate-specific antigene (PSA) level, the Gleason score of biopsy material and the results of the digital rectal examination for diagnostics of the extent of tumor spread. For low risk cancers (PSA < 10 ng/ml, cT1c-cT2a and Gleason sum a parts per thousand currency signaEuro parts per thousand 6) no further imaging diagnostics should be performed. Radical prostatectomy can be performed by open surgery (ORP), laparoscopically (LRP) or robot-assisted (RALP). In a prospective randomized trial radical prostatectomy significantly reduced local progression, distant metastases and prostate cancer mortality compared to watchful waiting. Progression-free survival after radical prostatectomy is > 80 % after 7 years and cancer-specific survival rates of > 90 % after 15 years have been reported. Perioperative complications are observed in 9 % of the patients. In recent retrospective studies incontinence rates between 8 and 11 % were reported. Depending on tumor stage a nerve sparing approach is possible and results in postoperative potency rates between 50 and 90 %. Surgeons experience is of paramount importance for the outcome of radical prostatectomy. Furthermore, comparisons of retrospective data suggest that RALP improves a number of short-term outcomes. Two randomized studies showed concordantly significantly better continence and potency rates after RALP compared to conventional LRP.