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<p>Locally advanced prostate cancer (PC) represents a&#xa0;complex therapeutic challenge, with multimodal treatment approaches becoming increasingly important. Radical prostatectomy with extended pelvic lymphadenectomy is a&#xa0;central part of treatment. Primary surgical therapy can be considered the first step in an individualized, stepwise treatment approach that allows for personalized treatment in combination with radiotherapy and systemic therapy. Postoperative therapy escalation should be based on histopathological findings and prostate-specific antigen (PSA) progression to avoid both overtreatment or undertreatment. Modern imaging techniques such as prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) improved staging accuracy; however, histopathological results remain crucial for definitive risk classification. The indication for surgical intervention requires careful consideration of the oncological benefits versus potential complications and postoperative functional impairments. The added benefit of surgical therapy as part of a&#xa0;multimodal treatment approach is still unclear based on current knowledge. This article provides a&#xa0;comprehensive overview of current surgical strategies and multidisciplinary treatment planning for locally advanced prostate cancer, with an emphasis on current evidence and guideline recommendations.</p>

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Lokal fortgeschrittenes Prostatakarzinom – chirurgische Aspekte

  • 期刊论文

  • 发表日期：

    2025年7月8日

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  • Ruth Himmelsbach,
  • Christian Gratzke,
  • August Sigle

摘要

Locally advanced prostate cancer (PC) represents a complex therapeutic challenge, with multimodal treatment approaches becoming increasingly important. Radical prostatectomy with extended pelvic lymphadenectomy is a central part of treatment. Primary surgical therapy can be considered the first step in an individualized, stepwise treatment approach that allows for personalized treatment in combination with radiotherapy and systemic therapy. Postoperative therapy escalation should be based on histopathological findings and prostate-specific antigen (PSA) progression to avoid both overtreatment or undertreatment. Modern imaging techniques such as prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) improved staging accuracy; however, histopathological results remain crucial for definitive risk classification. The indication for surgical intervention requires careful consideration of the oncological benefits versus potential complications and postoperative functional impairments. The added benefit of surgical therapy as part of a multimodal treatment approach is still unclear based on current knowledge. This article provides a comprehensive overview of current surgical strategies and multidisciplinary treatment planning for locally advanced prostate cancer, with an emphasis on current evidence and guideline recommendations.