Diagnosis and prognosis:
Only this surgery gives us a precise idea of the real local extension of the tumor because all the specimen is analysed by a specialist in histopathology.
This real extension can be appreciated formally neither from biopsies alone, nor from imaging, exploration including magnetic resonance imaging (MRI).
It is essential to estimate the real stage of evolution of the tumor, for prognosis and to better guide the therapeutic choices. The anatomo-pathological examination of the removed prostate thus gives essential information on:
- The real size of the tumor, the existence of a unique cancerous focus or multiple foci, the mapping of the cancer in the gland, to compare with the preoperative information provided from biopsies and imaging;
- The real degree of differentiation of cancer, the Gleason score being sometimes underestimated on the biopsies compared with the reality; the status of the surgical margins with regard to the tumor: healthy or invaded;
- The status of the prostatic capsule in regards to the tumor: close to the capsule, coming to its contact or exceeding it;
- The status of seminal vesicles and vas deferens in regards to the tumor: healthy or invaded, and then at which level and in which proportions.
Surgery also assures the highest rate of long-term cures.
If regrettably a local recurrence arises, the diagnosis can be established more prematurely because to the rate of PSA after surgery is without ambiguity: it is indosable, which is not the case with other treatments where the tumoral prostate was preserved.
Finally, in case of local recurrence after prostatectomy, many patients can be again cured with external beam radiation therapy, while in the inverse case of failure of the irradiation, it is not possible to operate further and to remove the cancerous prostate, without accepting major risks of complications and invalidating side effects.