Surreal illustration of a glowing prostate in a surgeon's hand, symbolizing hope in prostate cancer treatment.

Conquering High-Risk Prostate Cancer: Is Radical Prostatectomy the Answer?

Elliot Brynn in Health & Wellness November 2025 • 5 min read.

"A Deep Dive into a Single-Institution Study on Achieving Radical Cure Through Prostatectomy Alone, and What It Means for Men Facing This Diagnosis"

Prostate cancer, like many serious illnesses, demands a careful strategy to determine the best course of action. It's not just about fighting the disease; it's about understanding its unique characteristics in each patient. Risk classification is a crucial part of this process, grouping patients based on combined clinical factors to tailor treatment. This method has become standard practice in the field, and the D'Amico classification is one of the most widely used models.

However, the effectiveness of treatments can vary. While the D'Amico model suggests that high-risk prostate cancer patients might not see optimal results from local treatment alone, a new study challenges this notion. Researchers at the National Kyushu Cancer Center in Japan have been investigating whether radical prostatectomy (RP) can, in fact, offer a complete cure for high-risk prostate cancer patients without additional pre-surgical treatments.

This article delves into the methods and findings of this study, examining its implications for how we approach high-risk prostate cancer treatment. It will explore whether surgery alone can truly be a radical cure and what factors might influence the success of such an approach, offering hope and new perspectives for patients and healthcare professionals alike.

The Radical Prostatectomy Study: Methods and Patient Groups

Surreal illustration of a glowing prostate in a surgeon's hand, symbolizing hope in prostate cancer treatment.

Between August 1998 and December 2008, a total of 436 Japanese patients underwent antegrade RP. After excluding 139 patients for various reasons—such as past hormonal therapy or unclear biopsy specimens—the remaining participants were categorized into risk groups according to the D'Amico criteria. The study carefully separated patients into low-, intermediate-, and high-risk groups, comprising 63, 122, and 112 patients, respectively. Additionally, a separate group of 25 patients initially classified as high-risk based solely on T2c stage (a measure of tumor size) was evaluated as an 'intermediate/high-risk' group.

The research team, led by Dr. Nobuki Furubayashi, meticulously analyzed patient data, focusing on factors such as PSA levels, Gleason scores from biopsies, and the extent of the cancer. The median follow-up period after surgery was 60 months, allowing the team to track the long-term outcomes of each patient. This thorough approach ensured that the results provided a comprehensive view of how radical prostatectomy performed in different risk categories.

Key components of the study included:

Detailed patient classification using D'Amico criteria.
Long-term follow-up to assess PSA failure-free rates.
Separate evaluation of patients with T2c stage tumors.

The findings revealed some surprising insights. While the biopsy Gleason score was a significant predictor of PSA failure, the high- and intermediate/high-risk groups showed no statistically significant difference in outcomes. This suggests that patients classified as high-risk based on cT2 stage only might be more appropriately considered as intermediate-risk. Furthermore, the study highlighted the importance of specimen-confined disease (SCD) and organ-confined disease (OCD) in predicting successful outcomes, meaning that when the cancer was contained within the prostate or the removed specimen, the chances of PSA failure were significantly lower.

Rethinking the Approach to High-Risk Prostate Cancer

This research offers a new perspective on treating high-risk prostate cancer. It suggests that radical prostatectomy alone can be a viable option for certain patients, particularly those classified as high-risk solely based on the T2c stage. These patients may experience outcomes similar to those in intermediate-risk groups, challenging the conventional wisdom that they require more aggressive, multi-modal treatment approaches. Ultimately, a more nuanced and individualized approach to risk stratification can lead to more effective and tailored treatment plans, offering better outcomes and improved quality of life for men facing a prostate cancer diagnosis.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3892/mco.2012.39, Alternate LINK

Title: Radical Prostatectomy As Radical Cure Of Prostate Cancer In A High-Risk Group: A Single-Institution Experience

Subject: Cancer Research

Journal: Molecular and Clinical Oncology

Publisher: Spandidos Publications

Authors: Nobuki Furubayashi, Motonobu Nakamura, Ken Hishikawa, Atsushi Fukuda, Takashi Matsumoto, Kenichi Nishiyama, Takeharu Yamanaka, Yoshihiro Hasegawa

Published: 2012-11-15

Everything You Need To Know

What is the role of risk classification, such as the D'Amico classification, in determining treatment strategies for prostate cancer?

Risk classification in prostate cancer treatment involves categorizing patients based on combined clinical factors to tailor treatment strategies. The D'Amico classification is a widely used model for this purpose, helping doctors determine the most appropriate approach for each patient. However, the D'Amico model might not fully capture the nuances of high-risk prostate cancer, as some patients may benefit from treatments traditionally reserved for lower-risk groups. Further research into refining risk stratification is essential for optimizing treatment outcomes.

How was the radical prostatectomy study designed, and what patient groups were included?

The study, conducted at the National Kyushu Cancer Center, involved 436 Japanese patients who underwent antegrade radical prostatectomy between 1998 and 2008. After exclusions, the remaining patients were categorized into risk groups according to the D'Amico criteria: low-, intermediate-, and high-risk. A group initially classified as high-risk based on T2c stage was evaluated separately. The research team analyzed patient data, focusing on factors such as PSA levels and Gleason scores, with a median follow-up of 60 months. This meticulous approach provided a comprehensive view of how radical prostatectomy performed in different risk categories.

What were the key findings of the radical prostatectomy study regarding high-risk prostate cancer patients?

The study revealed that the biopsy Gleason score was a significant predictor of PSA failure. Interestingly, the high- and intermediate/high-risk groups showed no statistically significant difference in outcomes. This suggests that patients classified as high-risk based solely on cT2 stage might be more appropriately considered as intermediate-risk. Specimen-confined disease (SCD) and organ-confined disease (OCD) were strong predictors of successful outcomes, indicating that when the cancer was contained within the prostate or the removed specimen, the chances of PSA failure were significantly lower. These findings challenge the traditional approach to high-risk prostate cancer treatment.

What is radical prostatectomy, and when might it be considered a suitable treatment option for high-risk prostate cancer?

Radical prostatectomy is a surgical procedure involving the removal of the entire prostate gland and some surrounding tissue. The study suggests that it can be a viable option for certain high-risk patients, particularly those classified as high-risk solely based on the T2c stage, potentially leading to outcomes similar to those in intermediate-risk groups. This challenges the conventional wisdom that these patients require more aggressive, multi-modal treatment approaches. However, radical prostatectomy may not be suitable for all patients, and treatment decisions should be based on a nuanced and individualized approach to risk stratification.

What are the implications of this research for how we approach high-risk prostate cancer treatment and risk stratification?

The research underscores the need for a more nuanced and individualized approach to risk stratification in prostate cancer treatment. This approach can lead to more effective and tailored treatment plans, offering better outcomes and improved quality of life for men facing a prostate cancer diagnosis. The study suggests that patients classified as high-risk solely based on the T2c stage may benefit from radical prostatectomy alone, challenging the conventional wisdom that they require more aggressive treatments. Ultimately, a more refined understanding of risk factors can lead to better-informed treatment decisions.