[Controversy regarding the therapeutic management of stage B2, C and D1 adenocarcinoma]

In Spain most prostate cancers are detected once they have already disseminated. The tumor, however, is localized to the prostate gland for a period of time before spreading to other structures. It is therefore important to underscore the value of early diagnosis. And if we take into account that the complications of radical prostatectomy have diminished and life expectancy of the general population has increased, undoubtedly an increased number of patients can benefit from surgery. Radical prostatectomy combined with pre and postoperative hormone therapy may enhance the quality of life of some patients with tumors extending beyond the capsule (clinical stage B2-C), including those with microscopic dissemination to the regional lymph nodes. Surgery should aim at complete removal of the pelvic tumor. Although a statistical relationship exists between blood PSA levels and tumor grade and size, elevation of PSA levels is not sufficient to predict malignancy or tumor spread and is of little value in predicting response to hormone therapy.