The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially described using a perineal approach, the procedure was later popularized using a retropubic one, after it was first described as such in 1948. The open surgical method has now largely been abandoned in favour of the minimally invasive robot-assisted method, which was first described in 2000. Until 1980, the procedure was hazardous, often accompanied by massive blood loss and poor outcomes. For patients in whom surgery is indicated, prostatectomy is increasingly being used as the first step in a multitherapeutic approach in advanced local, and even early metastatic, disease. However, contemporary molecular insights have enabled many men to safely avoid surgical intervention when the disease is phenotypically indolent and use of active surveillance programmes continues to expand worldwide. In 2020, surgery is not recommended in those men with low-grade, low-volume Gleason 6 prostate cancer; previously these men - a large cohort of ~40% of men with newly diagnosed prostate cancer - were offered surgery in large numbers, with little clinical benefit and considerable adverse effects. Radical prostatectomy is appropriate for men with intermediate-risk and high-risk disease (Gleason score 7-9 or Grade Groups 2-5) in whom radical prostatectomy prevents further metastatic seeding of potentially lethal clones of prostate cancer cells. Small series have suggested that it might be appropriate to offer radical prostatectomy to men presenting with small metastatic burden (nodal and or bone) as part of a multimodal therapeutic approach. Furthermore, surgical treatment of prostate cancer has been reported in cohorts of octogenarian men in good health with minimal comorbidities, when 20 years ago such men were rarely treated surgically even when diagnosed with localized high-risk disease. As medical therapies for prostate cancer continue to increase, the use of surgery might seem to be less relevant; however, the changing demographics of prostate cancer means that radical prostatectomy remains an important and useful option in many men, with a changing indication.

中文翻译：

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考虑到前列腺癌根治术在21世纪前列腺癌治疗中的作用。

自从1900年左右全面引入前列腺癌以来，根治性前列腺切除术的治疗方法已有显着发展。最初使用会阴法进行描述，后来在1948年首次采用耻骨后方法进行了普及。开放式外科手术方法如今，在很大程度上已放弃了微创机器人辅助方法，该方法于2000年首次被描述。直到1980年，该过程都是危险的，通常伴随着大量失血和不良预后。对于需要手术治疗的患者，前列腺切除术正越来越多地被用作晚期局部甚至早期转移性疾病的多治疗方法的第一步。然而，当疾病在表型上是惰性的并且主动监测程序的使用在世界范围内不断扩展时，现代分子观点使许多男人能够安全地避免手术干预。在2020年，不建议那些患有低级别，小容量Gleason 6前列腺癌的男性进行手术；以前，这些人（约占新诊断的前列腺癌男人的40％）在接受大量手术后，几乎没有临床益处，而且副作用明显。根治性前列腺切除术适用于中度和高危疾病（格里森评分7-9或2-5级组）的男性，其中根治性前列腺切除术可防止进一步转移潜在的致命性前列腺癌细胞克隆的转移。小系列研究表明，作为多模式治疗方法的一部分，对转移负荷较小的人（淋巴结或骨骼）行根治性前列腺切除术可能是合适的。此外，据报导，在健康状况良好，并发症最少的八十岁男性队列中，对前列腺癌进行了手术治疗，而在20年前，即使被诊断出患有局部高危疾病，这类男性也很少接受手术治疗。随着用于前列腺癌的医学疗法的不断增加，外科手术的使用似乎不再那么重要。但是，前列腺癌的人口统计学变化意味着，在许多男性患者中，根治性前列腺切除术仍然是重要且有用的选择，并且适应症也不断变化。据报道，队列健康良好的八十岁男性队列研究的前列腺癌手术治疗，合并症极少，而二十年前，即使被诊断出患有局部高危疾病，这类男性也很少接受手术治疗。随着用于前列腺癌的医学疗法的不断增加，外科手术的使用似乎不再那么重要。但是，前列腺癌的人口统计学变化意味着，在许多男性患者中，根治性前列腺切除术仍然是重要且有用的选择，适应症也在不断变化。据报道，队列健康良好的八十岁男性队列研究的前列腺癌手术治疗，合并症极少，而二十年前，即使被诊断出患有局部高危疾病，这类男性也很少接受手术治疗。随着用于前列腺癌的医学疗法的不断增加，外科手术的使用似乎不再那么重要。但是，前列腺癌的人口统计学变化意味着，在许多男性患者中，根治性前列腺切除术仍然是重要且有用的选择，并且适应症也不断变化。手术的使用似乎不太相关；但是，前列腺癌的人口统计学变化意味着，在许多男性患者中，根治性前列腺切除术仍然是重要且有用的选择，其适应症也在不断变化。手术的使用似乎不太相关；但是，前列腺癌的人口统计学变化意味着，在许多男性患者中，根治性前列腺切除术仍然是重要且有用的选择，并且适应症也不断变化。