European urology supplements vol:10 issue:2 pages:218-218
Introduction & Objectives:
Surgical management of locally advanced Prostate cancer is gradually being accepted by the urological community. However, the evidence for this is mainly based on rather small surgical series in highly selected patients. The objective of this study is to present the oncologic outcomes and determine prognostic factors in cancer specific survival (CSS) and overall survival (OS) in the largest multicenter series of cT3a prostate cancer to date.
Materials & Methods:
Between 1987 and 2009, 888 patients with clinical T3a prostate cancer underwent RP and bilateral pelvic LND in 8 European tertiary referral centers. All patients had no evidence of nodal disease or distant metastasis on both contrast-enhanced computed tomography of the pelvis and
bone scan. The last PSA value obtained prior to prostate biopsies was used in the analysis. Kaplan–Meier analysis was used to calculate CSS and OS. The uni- and multivariate Cox proportional hazard analysis were used to determine the
predictive power of clinical and pathological variables in CSS and OS.
Results: Mean follow-up was 64.6 months (range 1 to 206). The mean preoperative PSA was 29.2 ng/ml (range 0.5 to 1710). Median final Gleason score was 7 (range 3 to 10). One hundred and seventy-four patients (19.6%) were
confirmed with organ confined disease (pT2); 625 (70.4%) were pT3 including 346 (39.0%) with extraprostatic extension only (pT3a) and 279 (31.4%) with seminal
vesicle invasion (pT3b); 89 (10.0%) had adjacent structure invasion (pT4). Two hundred and thirteen patients (24.0%) had lymph node involvement. Four hundred and eleven patients (46.3%) had positive surgical margins. Adjuvant therapy was administered to 52.5% (9.8% radiotherapy, 42.7% hormonal therapy). At 5- and 10-year follow-up, CSS was 94.8% and 89.5 and OS was 89.5% and 71.7%, respectively. Multivariate Cox proportional hazard analysis is displayed in the table below.
Conclusions: RP is a valuable treatment option for cT3a prostate cancer, with a 10-year CSS of 89.5%. However, half of the patients might need adjuvant treatment. Margin status, final Gleason score, pathological stage and nodal status were significant predictors of CSS.