20-Year survival after radical prostatectomy as initial treatment for cT3 prostate cancer

Departments of Urology Health Sciences Research, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
BJU International (Impact Factor: 3.53). 08/2012; 110(11). DOI: 10.1111/j.1464-410X.2012.11372.x
Source: PubMed


OBJECTIVE To present long-term survival outcomes after radical prostatectomy (RP) for patients with cT3 prostate cancer, as the optimal treatment for patients with clinical T3 prostate cancer is debated. PATIENTS AND METHODS We identified 843 men who underwent RP for cT3 tumours between 1987 and 1997. Survival was estimated using the KaplanMeier method. Cox proportional hazards regression models were used to evaluate the association of clinicopathological features with outcome RESULTS The median (range) postoperative follow-up was 14.3 (0.123.5) years. Down-staging to pT2 disease occurred in 26% (223/843) at surgery. Local recurrence-free, systemic progression-free and cancer-specific survival for men with cT3 prostate cancer after RP was 76%, 72%, and 81%, respectively, at 20 years. On multivariate analysis, increasing RP Gleason score (hazard ratio [HR] 1.8; P= 0.01), non-diploid chromatin content (HR 1.8; P= 0.01), positive surgical margins (HR 2.1; P= 0.007), and seminal vesicle invasion (HR 2.1; P= 0.005) were associated with a significant risk of prostate cancer death, while a more recent year of surgery was associated with a decreased risk of cancer-specific mortality (HR 0.88; P= 0.01) CONCLUSIONS RP affords accurate pathological staging and may be associated with durable cancer control for cT3 prostate cancer, with 20 years of follow-up presented here. RP as part of a multimodal treatment strategy therefore remains a viable treatment option for patients with cT3 tumours.

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    • "This might also reduce the incidence of disease up-and downstaging , which have been reported from radical prostatectomy series in men with apparent clinical T3 disease at presentation [42]. Of note, these studies (although not comparing with radical radiotherapy) have shown encouraging results from radical prostatectomy as a monomodality therapy for initial T3 disease [42] [43]. Nevertheless , although in localised disease the evidence base for radical radiotherapy and radical prostatectomy may arguably show equivalence of outcomes, the same cannot currently be said of locally advanced disease because of the paucity of good-quality radical prostatectomy data that in the main have come from single institution case series. "
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