[Radical prostatectomy and adjuvant endocrine treatment of prostatic cancer with lymphatic metastasis?].

The limits of curability of prostate cancer still have not been exactly defined. Data derived of randomized, retrospective comparative studies of patients with positive lymph nodes suggest an advantage in overall survival and cancer mortality if such tumors are treated by means of radical prostatectomy with immediate adjuvant endocrine therapy. An analysis of such publications, however, shows that the more favourable results are based on the unequal distribution of important prognostic factors. Several publications agree that adjuvant endocrine treatment in N+ disease leads to a prolongation of time to progression which is clinically and statistically significant. Up to now, however, a significant prolongation of survival has not been shown with early endocrine treatment. Patients have a choice between an initial short period of time until progression occurs if endocrine treatment is delayed. During this time they will be sexually potent. On the other hand, for the price of loss of potency and libido an initial longer period of time free of progression can be expected. It is unclear at this moment whether it makes sense to carry out a radical prostatectomy for palliative reasons. To come to a proper decision it is necessary to compare the risk of the untreated primary tumour and the risk of the radical prostatectomy in this situation. This comparison is very difficult and depends on factors which are not ready for comparison at this moment. Local progression under endocrine treatment is relatively rare and can usually be controlled by conservative means (TUR, radiotherapy). At this moment there are insufficient arguments to carry out palliative radical prostatectomy as a routine in lymph node positive patients.