Is radical prostatectomy an option in high-risk prostate cancer patients?

Long term survival of men with high-risk (T3 and/or PSA>20 ng/ml and/or Gleason>or=8) prostate cancer is still far from satisfaction. Common treatment options for these patients usually include hormonal therapy, radiation therapy or a combination of both. Radical prostatectomy has not been considered as the standard treatment strategy in these cases, while the potential for incomplete excision of the local tumor and high incidence of lymph node metastasis. This raises the question under which conditions a properly executed radical prostatectomy in high risk prostate cancer might provide a better course of action? Systematic review has shown that high risk prostate cancer men can be successfully treated with radical prostatectomy. However radical prostatectomy can not be considered as the monotherapy in this cohort of patients, but as a part of multimodal treatment, which can include radiation, hormonal and chemotherapies.