[New review of radical prostatectomy]

The author raises some doubts regarding arguments that have been used to justify the increase in the number of radical prostatectomies in localized prostate cancer. In well or moderately differentiated localized prostate cancer who undergo radical prostatectomy do not show marked differences in mortality in relation to patients subjected only to watchful waiting. Results between the two groups are similar even though their being slanted by significant differences between the two groups in the definition of tumour staging. Characterization is much more accurate in cases undergoing radical prostatectomy, where tumours not confined to the prostate are excluded from the operation by histological examination of regional lymph-nodes. This fact is clearly unfavourable in cases where conservative therapy is used and in which, frequently carcinomas apparently confined to the prostate are included, even though they are not really localized. The author concentrates on patients with undifferentiated, highly aggressive, tumours that seem to call for equally aggressive therapy. Radical prostatectomy has exhibited a cure rate in these patients which, though not very high, bears substantial significance since, without treatment, this type of aggressive carcinomas kills nearly one hundred percent of the patients.