[Role of surgery in stade cT3-4 N0M0 prostate cancer]

The surgical treatment of locally advanced prostate cancer has often been discouraged and in many cases a combined treatment with radiotherapy and hormone-therapy is proposed. Nevertheless, radical prostatectomy is efficient in mono-therapy in the majority of patients with a PSA lower than 20 microg/l, a unilateral stage T3a and a Gleason score lower than 8. Patients with a more advanced local stage or with a less well differentiated tumour should not be excluded from a surgical treatment as an initial option. The majority of them will benefit from a multimodal treatment. This can consist of adjuvant radiotherapy in case of obvious margin positive disease, a salvage radiotherapy in case of PSA relapse during follow-up, or a hormonal treatment in case of PSA persistence after surgery or in cases of advanced lymph node invasion. The urologist must utilise the results of the definitive pathology and of the post-operative PSA levels in order to find the indications where and when additional treatment can be applied. The results obtained after 10-15 years with a radical prostatectomy, eventually combined with radiation or hormonal treatment are excellent concerning the cancer specific survival at long term. Therefore radiotherapy and hormones is not the treatment of choice for all clinical T3 prostate cancers.