Early detection and associated stage migration identify a cadre of men with unfavorable but apparently localized
prostate cancer who historically would not have been viewed as appropriate candidates for radical
prostatectomy. Decreased morbidity from radical
prostatectomy and data demonstrating improved outcomes in some patients treated with multimodal
therapy protocols provide a rationale for including radical
prostatectomy as part of an aggressive treatment plan to achieve optimal local elimination of
cancer. Data suggest that radical
prostatectomy and adjuvant or possibly even salvage
radiation therapy may provide the best elimination of large local
cancers. Whether such an approach provides results that are better than or even as good as those of the common standard of
radiation therapy plus
androgen deprivation
therapy remains to be seen and, if so, at what cost to the patient in terms of adverse effects. However, it is likely that optimal elimination of local disease is needed to achieve the maximum benefit from adjuvant systemic endocrine,
chemotherapy or targeted treatments. In other words optimal local
therapy may be necessary but not sufficient.
CONCLUSIONS: