Palliative surgery for locally advanced prostate cancer

Local progression of prostate cancer occurs when the tumor grows beyond the prostatic capsule and invades adjacent structures such as the urinary bladder, rectum, pelvic side-wall and ureters. This is an important clinical event that can in itself cause significant morbidity, impaired quality of life and even mortality. Patients with this condition may experience urinary symptoms due to bladder outlet obstruction by the tumor mass, ureteral obstruction and renal failure, hematuria due to invasion of the tumor into the bladder, and pelvic pain, constipation or tenesmus, as a result of rectal involvement. In the absence of metastasis, some patients with locally advanced prostate cancer (LAPC) may survive for longer than 5 years. Therefore, effective and durable palliation is necessary to reduce morbidity and maintain patient quality of life. Although the majority of the patients with LAPC cannot be cured by any currently available modality, effective palliation is an independent clinical endpoint. This article presents the LAPC syndrome and treatment options.