The Surgical Management of Prostate Cancer

Prostate cancer is a heterogeneous disease with a variable natural history. Therefore, optimal management remains challenging. While many men with newly diagnosed prostate cancer may be candidates for active surveillance, there are others who will benefit from aggressive local therapy. Radical prostatectomy is associated with improvements in cancer-specific mortality, metastasis-free survival, and need for palliative treatments when compared with observation in several randomized controlled trials. Additionally, radical prostatectomy may have some oncologic benefit over radiation therapy. All aggressive therapy for prostate cancer negatively impacts erectile function and urinary continence. The decision for which treatment modality to pursue should incorporate shared decision making and consider cancer risk and severity in addition to patient preferences.