TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: To analyze oncological outcomes after radical prostatectomy for high-risk prostate cancers.
Methods: From November 1996 to January 2014, all D’Amico high-risk prostate cancers with radical prostatectomy performed were included. Pathological and oncological outcomes were analyzed.
Results: 92 patients with 24 open, 7 laparosocopic, and 61 robotic prostatectomies were included. Pre-operative mean PSA was 25.4 + / - 23 ng/ml, and 48.9% had palpable prostate nodule. 57.6% patients had pre-operative Gleason score 8–10. Pathological staging showed 25.0% T2c, 31.5% T3a and 25.0% T3b. Pathological N1 was seen in 8.7% patients. There were 35.2% Gleason 7 and 34.3% Gleason 8–10. Positive surgical margin rate was 34.8%. There was a trend towards lower positive surgical margins in robotic group (29.5%) compared with laparoscopic (42.9%) and open (45.8%) groups. Excluding 13 patients with early post-operative androgen deprivation therapy (ADT), 71.8% had undetectable PSA nadir, and there was no difference comparing different surgical approaches. At a median follow-up of 4.5 (range 0.1–17.5) years, 18.2% had biochemical recurrence, 11.7% had adjuvant radiotherapy, 10.4% had salvage radio-therapy, 14.4% had early ADT, 22.2% had late ADT, 6.7% had metastasis, 3.3% reached castration resistant status, and 3.3% died of prostate cancer. On the whole, 48.9% patients required adjuvant therapy. For patients with N1 disease with early ADT given, 12.5% had castration resistance but none of them died at a median follow-up of 10 years.
Conclusions: Radical prostatectomy with adjuvant therapy provided good cancer control and long-term survival in high-risk prostate cancers.
Source of Funding: None
|Listen to an interview with Peter Ka-Fung Chiu, one of the authors of this study.|
Presented by Peter Ka-Fung Chiu, Kim W.M. Lee, Simon S.M. Hou, Chi-Fai Ng at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong