Surgical management of prostate cancer

Prostate cancer represents an enormous public health challenge, in part because of the difficulty in distinguishing between nonaggressive disease that can be safely observed and more aggressive disease that warrants treatment. This chapter presents the data that guide clinicians on four important questions that arise with respect to the surgical management of clinically localized and locally advanced prostate cancer. It explores the benefit of surgical intervention compared with observation. The chapter describes the use of neoadjuvant androgen deprivation therapy (ADT) to improve outcomes over radical prostatectomy alone. It also explores the role of neoadjuvant systemic chemotherapy to improve outcomes over radical prostatectomy alone. Currently, there is no evidence that adjuvant chemotherapy for locally advanced or lymph node-positive disease provides a benefit in patients with locally advanced or nodal disease following radical prostatectomy and, again, chemotherapy is associated with significant side effects.