**RP in locally advanced PCa: cT3a**

prostatectomy is offered as a radical treatment.

Is defined, as cancer that has perforated the prostate capsule. Surgical treatment has traditionally been discouraged, mainly because patients have an increased risk of positive surgical margins and lymph node metastases and/or distant relapse

In recent years, there has been renewed interest in surgery for locally advanced PCa, and several retrospective case-series have been published. In general, 33.5-66% of patients will have positive section margins, and 7.9-49% will have positive lymph nodes.

On the other hand, excellent 5-, 10- and 15-year overall survival (OS) and cancer-specific survival (CSS) rates have been published.

Therefore, it is increasingly evident that surgery has a place in treating locally advanced disease (45)

As mentioned above, the multimodal treatment is achieving good results, and to corroborate this, several randomised studies of radiotherapy combined with androgen-deprivation therapy (ADT) versus radiotherapy alone have shown a clear advantage for combination

Actually radical prostatectomy is accepted as an election treatment in both low and high risk prostate cancer with different evidence level, and even for very high risk prostate

Gleason score 2-7 and PSA ≤ 20) and a life expectancy > 10 years 1b

Patients with stage T1a disease and a life expectancy >15 yr or Gleason score 7 3

score 8-10 or PSA > 20) <sup>3</sup>

score ≤ 8 and a life expectancy > 10 years. <sup>3</sup>

The goals of RP are to remove the cancer completely with negative surgical margins, minimal blood loss, no serious perioperative complications, and complete recovery of potency and urinary continence. From an oncologic standpoint, obtaining negative surgical margins is paramount. A positive surgical margin has been associated with as much as 4-fold higher risk of biochemical recurrence, even after adjusting for other prognostic factors such as Gleason grade, extracapsular extension, seminal vesicle invasion, and lymph node metastasis. (48) On the same way, there are good results in terms of morbidity and survival when radical

Is defined, as cancer that has perforated the prostate capsule. Surgical treatment has traditionally been discouraged, mainly because patients have an increased risk of positive

In recent years, there has been renewed interest in surgery for locally advanced PCa, and several retrospective case-series have been published. In general, 33.5-66% of patients will

On the other hand, excellent 5-, 10- and 15-year overall survival (OS) and cancer-specific

Therefore, it is increasingly evident that surgery has a place in treating locally advanced

surgical margins and lymph node metastases and/or distant relapse

have positive section margins, and 7.9-49% will have positive lymph nodes.

INDICATIONS LE

treatment, but no trial has ever proven combined treatment to be superior to RP.

In patients with low and intermediate risk localised PCa (cT1a-T2b and

Optional

Selected patients with low-volume high-risk localised PCa (cT3a or Gleason

Highly selected patients with very high-risk localised PCa (cT3b-T4 N0 or any T N1) in the context of multimodality treatment <sup>3</sup>

Optional for selected patients with T3a, PSA < 20 ng/mL, biopsy Gleason

**4. Radical prostatectomy in high risk CaP** 

prostatectomy is offered as a radical treatment.

survival (CSS) rates have been published.

**4.2 Evidence of RP in HR.PC RP in locally advanced PCa: cT3a** 

**4.1 Introduction** 

cancer. (Table 3)

Table 3.

disease (45)

The problem remains on patient selection before surgery: Nomograms, nodal imaging with CT and seminal vesicle imaging with magnetic resonance or directed specific puncture biopsies of the nodes or seminal vesicles can help to identify those patients unlikely to benefit from a surgical approach. (17)

In addition, it is extremely important that radical prostatectomy for clinical T3 cancer requires sufficient surgical expertise to keep an acceptable morbidity level.
