The radical prostatectomy is ideally suited to patients still “young”, in good general condition and carrying a cancerous tumor that the data collected by the preoperative assessment make it possible to hope localized, intracapsular.
The patient’s age is therefore an important criterion for assessing the indication of surgery.
The natural history of prostate cancer tells us that it is a relatively slow developmental disease. Only patients with a life expectancy of at least ten years will benefit from surgery.
This is not indicated beyond the age of 75 years. In other patients, the surgical indication is all the more necessary because it is a younger subject and the tumor appears to be less differentiated and therefore more evolutionary (Gleason score).
The general condition and patient history are also an important part of the therapeutic decision.
A precarious cardiological or respiratory condition, a blood clotting disorder, severe neurological disorders, for example, may lead to the rejection of a surgical indication.
Severe weight loss, a history of abdominal or pelvic surgery and especially urinary surgery (preoperative surgery of benign prostatic hyperplasia by natural or open route) are not contraindications but represent elements of the foreseeable Surgery to be assessed on a case by case basis.
The surgery is finally addressed to localized forms of prostate cancer, as evaluated by the assessment of extension realized in view of the result of biopsies.
Ideally, the tumor is intracapsular, unilateral or bilateral, there is no evidence of involvement of the seminal vesicles or invasion of the pelvic ganglia.
Elements to evaluate these different criteria are the rate of prostate specific antigen (PSA) during diagnosis, the number of positive prostate biopsies compared to the total number of biopsies performed and the length of cancerous tissue compared to The total length of the biopsied prostatic tissue. Imaging, endo-rectal ultrasound and especially prostate magnetic resonance examination also provide important information.
Statistical tools (Cattan’s nomograms, Partin’s tables) can help to make the therapeutic decision that results from the balancing of a set of arguments, because often none of these prognostic elements taken in isolation has a Formal value.
If there is a tumor overshoot of the capsule indicating local invasion by the cancer, there is no consensus among the surgeons and some consider the surgical indication on a case-by-case basis by warning the patient that complementary treatments post- (Radiotherapy, chemotherapy, possibly within the framework of protocols) will probably be necessary in the light of the definitive conclusions of the anatomo-pathology examination of the prostatectomy part.
They follow the attitude adopted for the treatment of other cancers, in particular the breast cancer with which prostate cancer shares much in common. It is in both cases of touching tumors sexual organs, hormone-dependent and for which there are in many cases a family, genetic or racial risk of occurrence.
Chemotherapy of advanced forms of prostate cancer has greatly benefited from the significant advances in clinical research in the treatment of breast cancer.