The role of radical prostatectomy for early stage prostate cancer

Recent understanding of the periprostatic anatomy has led to an anatomical approach to radical prostatectomy, with reduced complications. Initially, a technique for management of the dorsal vein complex was developed that enabled the surgeon to perform a precise anatomic dissection at the apex of the prostate. Subsequently, the precise anatomy of the pelvic plexus and the branches that innervate the corpora cavernosa was studied. This led to the development of nerve-sparing radical prostatectomy. With the increasing chance of finding an early stage prostate cancer, radical prostatectomy has gained wide popularity even in Japan. On the other hand, the indications for radical prostatectomy are still controversial, especially for locally advanced (stages C) prostate cancer. Surgical staging is considered to be mandatory, because once pelvic lymphnode metastases are identified, the prognosis is unfavorable irrespective of the mode of treatment. Minimally invasive approaches including laparoscopic pelvic lymphadenectomy have been developed for lymphnode staging. The significance of the neoadjuvant hormonal treatment for locally advanced prostate cancer should be carefully discussed with regard to the long-term outcome.