EAU 2017: Assessing the 20-year outcomes of radical prostatectomy for high risk prostate cancer: Results from a large, multi-institutional series

London, England (UroToday.com) Long-term updated outcomes help us understand the natural history of a disease with a long clinical course. The authors utilize their multi-institutional database to explore the 20-year outcomes for surgically-treated high-risk prostate cancer (HRPCa) patients.

They were able to identify 2280 patients with HRPCa treated with radical prostatectomy (RP) and pelvic lymph node dissection (PLND) at 3 tertiary care centers between 1986 and 2015. Median follow-up was 210 months, though the range was not listed – though only 74 patients had follow-up greater than 20 years. High-risk prostate cancer was defined as the presence of at least 1 of the following criteria: PSA>20 ng/ml, clinical stage T3 and biopsy Gleason 8-10. 

The 20 year BCR-free survival and CR-free survival rates were 36.7% and 76.3%. Interestingly, the longest time frame to BCR was 237 months after RP! Overall, 394 and 172 patients experienced OCM and CSM. A nice Kaplan-Meier curve demonstrates that the competing risk 20-years CSM and OCM rates were 12.4 and 30.8%, respectively. Among patients with a follow-up ≥20 years (n=74), 39 (51.3%) experienced BCR at a median follow-up of 214 months (17 years) - no patient developed BCR after 20 years from RP.

This paper highlights the fact that patients with high-risk prostate cancer are always susceptible to recurrent disease, even > 5-10 years after RP. Indeed, 11% of patients died of disease between year 11-20. As such, long-term follow-up is required.

Limitations / Discussion / Future Directions:

1. While some patients had longer follow-up, the range was very wide. Limiting to patients with a minimum 5-10 year follow-up would have been useful.
2. In the Q&A session, the question was asked – how is it feasible for the urologist to follow every patient for that long? Answer – its not. Patient needs to be informed, and counseled to follow regularly with PSA’s.
3. It was also noted that the kinetics of cancers that recur much later is not known in this study – they well may be very slow-growing and managed expectantly.

Presented by: M. Bianchi

Co-authors: Colicchia M., Gandaglia G., Munegato S., Fossati N., Bandini M., Stabile A., Dell'Oglio P., Suardi N., Gontero P., Karnes J., Joniau S., Spahn M., Montorsi F., Briganti A.

Institutions:
1. Magna Graecia University, Dept. of Urology, Catanzaro, Italy
2. Vita-Salute University San Raffaele, Dept. of Urology, Milan, Italy
3. Mayo Clinic, Dept. of Urology, Rochester, United States of America 
4. Molinette Hospital, Dept. of Urology, Turin, Italy
5. University Hospitals Leuven, Dept. of Urology, Leuven, Belgium
6. University Hospital of Bern, Dept. of Urology, Bern, Switzerland

Written by: Thenappan Chandrasekar, Clinical Fellow, University of Toronto

at the #EAU17 -March 24-28, 2017- London, England


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