European urology supplements vol:6 issue:2 pages:278-278
Comparing the outcome of patients with adjuvant or salvage treatment in clinical unilateral T3a prostate cancer
Hsu C.y.1, Joniau S.1, Oyen R.2, Roskams T.3, Van Poppel H.1
1KULeuven, Urology, Leuven, Belgium, 2KULeuven, Radiology, Leuven, Belgium,
3KULeuven, Pathology, Leuven, Belgium
Introduction & Objectives: In locally advanced prostate cancer, surgery alone will cure only a small part of the patients (30-44%). Multimodality treatment consisting
of radical prostatectomy (RP) with adjuvant or salvage androgen deprivation therapy (ADT) or radiotherapy (RT) is often needed. It is however not well studied whether patients who received adjuvant treatment fare better or worse than those who receive salvage treatment.
Material & Methods: Between 1987 and 2004, 200 patients were assessed as unilateral cT3a prostate cancer by digital rectal examination at our institution. All patients underwent RP and bilateral extended lymphadenectomy. No patient received neo-adjuvant treatment by either hormones or radiation. Adjuvant treatment is defined as either RT or ADT given within 90 days after RP; salvage treatment is defined as either RT or ADT given postoperatively after 90 days. The Kaplan–Meier method was used to analysis the survival rates.
Results: Forty-four (22%) patients received adjuvant treatment because of detectable PSA post-surgery or because of positive surgical margins, salvage treatment was given in 68 (34%) patients because of late biochemical or late clinical failure (PSA ≥ 0.2 ng/ml and rising). The mean follow-up from RP was 74.7 months (range 7 to 184). A significant difference was found in mean pre-operative PSA
between adjuvant and salvage groups (26.08 vs. 13.97 ng/ml, p=0.0019). Also, significant differences between these two groups were recorded in positive lymph node (p<0.0001) and positive margin rate (p=0.0181). However, Kaplan-Meier
analysis showed there were no significant differences in cancer specific survival (CSS) (p=0.29) and overall survival rate (OS) (p=0.29) between both groups.
Conclusions: Multimodality treatment, consisting of surgery and RT or ADT, is often necessary in the treatment of locally advanced prostate cancer. CSS and OS rates do not seem to differ between both groups after a follow-up op 74.7 months.