Men Undergoing Radical Prostatectomy For Stage T3 Prostate Cancer Can Experience Good Long-term Outcomes

UroToday.com - Men with clinical stage T3 prostate cancer (CaP) are often found to have locally advanced or regional disease. As such, radiotherapy with androgen deprivation is most commonly employed. Dr. Carver and colleagues at Memorial Sloan Kettering Cancer Center reviewed the outcomes of 176 men who had radical prostatectomy (RP) for stage T3 CaP. Their report appears in the August, 2006 issue of the Journal of Urology.

Men included in the study underwent RP between 1983 and 2003. Clinical staging was provided by the attending surgeon. Neoadjuvant hormonal therapy (NHT) was given to 64/176 men and the remainder had RP as monotherapy. No participant received adjuvant hormonal therapy. Biochemical recurrence (BCR) was defined as a PSA >0.2ng/ml. Clinical and pathologic data was obtained and analyzed.

Men treated with NHT had higher mean pretreatment PSA levels and a greater incidence of clinical seminal vesicle invasion. Downstaging to a pathologically organ confined tumor occurred in 24% of men who had RP as monotherapy and in 41% of men who had NHT. Positive surgical margins occurred in 24% of men who had RP as monotherapy and in 31% of men who had NHT. BCR was found in 84/176 (48%) at a mean time of 4.6 years after surgery. The 10-year probability of freedom from BCR for men with PSA levels <10ng/ml, 10-20ng/ml, and >20ng/ml was 68%, 50%, and 20%, respectively. NHT was not a predictor of BCR.

Salvage radiotherapy was given to 10% of men at BCR. Of the 84 men with a BCR, 65 (77%) were treated with androgen deprivation at a median time of 1.4 years after surgery. After initiation of androgen deprivation, 69% achieved an undetectable PSA nadir level. 26/65 men (40%) had progression to hormone refractory disease. The overall probability of freedom from clinical failure at 5 and 10 years was 86% and 76%, respectively. At a median follow-up of 6.4 years, 82% of men are alive, 11% died of CaP, and 7% died of other causes. The overall probability of death from CaP at 5, 10, and 15 years after RP was 6%, 15%, and 24%, respectively. Fifty-two percent of men who had RP for clinical stage T3 disease were free of disease recurrence.

Christopher P. Evans, M.D.
J Urol 2006;176:564-8. Link Here

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