Results of radical prostatectomy in men with locally advanced prostate cancer: multi-institutional pooled analysis

• Published in: European urology Vol. 32; no. 4; p. 385
• Main Authors: Gerber, G S, Thisted, R A, Chodak, G W, Schroder, F H, Frohmuller, H G, Scardino, P T, Paulson, D F, Middleton, Jr, A W, Rukstalis, D B, Smith, Jr, J A, Ohori, M, Theiss, M, Schellhammer, P F
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-1997
• Subjects: Adult; Aged; Aged, 80 and over; Disease-Free Survival; Humans; Male; Middle Aged; Neoplasm Staging; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Retrospective Studies
• ISSN: 0302-2838
• DOI: 10.1159/000480794

We investigated the disease-specific and metastasis-free survival rates in men with locally advanced (clinical stage T3) prostate cancer who were treated surgically.
A retrospective, multi-institutional pooled analysis of the results of surgical treatment in 345 men with clinical stage T3 disease was performed. Survival curves were generated using the Kaplan-Meier method.
Among 298 evaluable patients, pelvic lymphadenectomy alone was performed in 56 men (19%), while 242 men (81%) underwent node dissection and radical prostatectomy. In total, 122 of 298 patients (41%) had nodal metastases and/or seminal vesicle tumor spread. Pathologically organ-confined disease was noted in 27 men (9%). The actuarial 10-year disease-specific and metastasis-free survival rates for all patients managed surgically were 57 and 32%, respectively. For patients with well, moderately and poorly differentiated tumors, cancer-specific survival rates at 10 years were 73, 67 and 29%, respectively.
A large number of men with clinical stage T3 prostate cancer have advanced disease and are unlikely to achieve improved long-term survival with surgery alone. Although there may be a role for radical prostatectomy in selected patients with low to intermediate grade tumors, such treatment appears unlikely to result in long-term survival in men with high grade disease. A prospective study is necessary to determine the optimal treatment approach in men with locally advanced prostate cancer.