High-risk prostate cancer: the role of surgical management

• High risk prostate cancer (HR PCa) is still a common disease despite extensive PSA screening.
• HR PCa is a highly heterogeneous disease, with many risk sub classification strategies have been proposed in the last years.
• There is growing evidence that active treatment, with either radiation therapy or surgery is associated with better outcomes.
• Surgery alone can achieve cure in a substantial portion of HRPCa men, and may be a valuable first step in a multimodal approach.

High-risk prostate cancer (HR Pca) is a highly heterogeneous disease from a biological and clinical standpoint, and it carries a significant chance of morbidity and mortality. Despite the impact of PSA screening, a significant number of men continue to present with high risk disease and need adequate management: clinical evidence shows that a considerable fraction on men with HR PCa can be actually cured with either uni- or multi-modality approaches. Surgical treatment, once considered unfeasible in this setting, is acquiring more and more diffusion in modern clinical practice. Herein we discuss the main treatment strategies for high-risk prostate cancer, providing an expert opinion on the role of surgical management and its outcomes in the most recent literature.