Radical
prostatectomy is the most frequently used treatment for localized
prostate cancer. In contrast to other strategies radical
prostatectomy has been shown to be superior to watchful waiting in a prospective randomized trial. According to the German S3 guideline patients have to be informed about the results of this trial prior to treatment decision. The aims and quality indicators of radical
prostatectomy include--as has also been defined by the German
Cancer Society for certified
prostate cancer centers--complete removal of the prostate with
negative surgical margins (R0) and preservation of continence as well as potency. In low-risk disease (according to D'Amico criteria) pelvic
lymph node dissection may be abandoned. If
lymphadenectomy is performed a minimum number of ten nodes should be obtained. An extended
lymphadenectomy is recommended in locally advanced disease.Radical
prostatectomy is a valid treatment option in locally advanced
prostate cancer. In cases with Gleason score > or = 8 or clinical stage cT3/4 magnetic resonance imaging of the pelvis should be performed prior to treatment decision making. In patients undergoing radical
prostatectomy (neo) adjuvant treatment should not be used (exception: adjuvant treatment for
lymph node metastases). For the first time the German S3 guideline determines minimum surgery volumes aimed at quality assurance. Radical
prostatectomy has to be performed under the supervision of an experienced surgeon. This includes the number of 50
prostatectomies per year and institution, 25
prostatectomies per surgeon, and an appropriate training program.