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Updated: May 28, 2026

A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
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Surgery for high-risk localized prostate cancer.

Jan Schmitges1, Quoc-Dien Trinh, Jochen Walz

  • 1Martiniklinik am Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.

Therapeutic Advances in Urology
|October 5, 2011
PubMed
Summary

Radical prostatectomy (RP) for high-risk prostate cancer (PCa) can achieve good functional and oncological outcomes. Nerve-sparing techniques and extended pelvic lymph node dissection (EPLND) are feasible and safe in these challenging cases.

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Prostate cancer.

Lancet (London, England)·2025

Area of Science:

  • Urology
  • Oncology
  • Surgical Oncology

Background:

  • High-risk prostate cancer (PCa) treatment is challenging due to complex natural history and unclear definitions.
  • Historically, radical prostatectomy (RP) for high-risk PCa was avoided due to perceived higher complication rates and poorer outcomes.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of radical prostatectomy (RP) in men with high-risk prostate cancer (PCa).
  • To assess the impact of nerve-sparing techniques and extended pelvic lymph node dissection (EPLND) on functional and oncological results in high-risk PCa patients.

Main Methods:

  • Review of existing data and investigator reports on radical prostatectomy (RP) outcomes in high-risk prostate cancer (PCa).
  • Analysis of continence rates, potency, surgical margin status, and perioperative morbidity associated with RP and extended pelvic lymph node dissection (EPLND).
Keywords:
high-risk prostate cancerperioperative complicationsprostatectomyurinary incontinence

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Main Results:

  • Continence rates appear unaffected in patients undergoing RP for high-risk PCa.
  • Nerve-sparing RP can be performed without compromising surgical margins or potency in a significant proportion of patients.
  • Extended pelvic lymph node dissection (EPLND) aids accurate staging with minimal impact on morbidity.

Conclusions:

  • Radical prostatectomy (RP) is a viable treatment option for high-risk prostate cancer (PCa), offering potential for local recurrence control and cure.
  • Realistic expectations regarding RP outcomes, alone or with multimodal therapy, should be discussed during patient counseling.
  • Functional outcomes like continence and potency, as well as oncological results, can be favorable in carefully selected high-risk PCa patients undergoing RP.