WASHINGTON, DC USA (UroToday.com) - Dr. Steven Joniau presented multi-institutional data that among select patients with high-risk prostate cancer (CaP), surgery alone has good outcomes.
The study aim was to investigate the cancer specific survival (CSS) of high-risk localized CaP patients who underwent surgery alone without adjuvant treatment. The database included 1,747 patients with pre-operative high-risk CaP (PSA>20 ng/ml or cT3-4 or biopsy Gleason 8-10) treated with radical retropubic prostatectomy (RRP) and pelvic LND at 9 tertiary referral centers between 1987 and 2009. Patients receiving neo-adjuvant or adjuvant (within 3 months) treatment were excluded from the analysis. Salvage therapy was administered according to institutional protocols.
A total of 516 patients met inclusion criteria for the analysis. Mean age at surgery was 64.8 yrs and mean pre-operative PSA was 20.7ng/ml. Final Gleason sum was 2-6, 7 and 8-10 in 32.8, 45.6 and 21.6%, respectively. Pathological stage was T2, T3a and >T3a in 37.1%, 43.1% and 19.8%, respectively. Margins were positive in 25.0%, and lymph nodes were positive in 8.2%. Salvage RT and HT were delivered to 19.0% and 20.3%, respectively. Overall, 322/516 (62.3%) patients had specimen confined CaP and had an excellent 10-year CSS compared to those without specimen confined CaP (97.1% vs. 91.0%, p=0.006). They were also less likely to receive salvage RT (13.2 vs. 30.1%, p<0.0001) and HT (8.7 vs. 41.6%, p<0.0001). Furthermore, patients who experienced biochemical recurrence within 24 months of surgery (21.1%) fared significantly worse compared to patients who experienced BR beyond 24 months (18.0%); the10-year CSS was 82.2% vs. 95.4%, respectively, p<0.0001.
Presented by Steven Joniau, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.