Radical prostatectomy for locally advanced prostate cancer shows long-term success

The results of a large study indicate that radical prostatectomy offers durable cancer control and survival rates 20 years following surgery for men with locally advanced prostate cancer.           

A relatively small subset of men with prostate cancer have clinical T3 (cT3; locally advanced) disease, and optimal treatment approaches remain unclear but veer toward nonsurgical choices. The current findings support a surgical alternative.

“While inferior to those of men with cT2 [localized] disease, oncologic outcomes for men with cT3 disease remain high with long-term follow-up,” concluded Christopher Mitchell, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues in their study abstract, presented at the annual meeting of the American Urological Association, held May 14-19, 2011, in Washington, D.C. (www.aua2011.org/abstracts/printpdf.cfm?ID=,339).

Mitchell's group identified 7,883 men who underwent radical prostatectomy in the early prostate-specific antigen (PSA) era of 1987 to 1997. Of these, 843 (15%) had been diagnosed with cT3 disease, but one-quarter of them were downstaged to pT2 at the time of surgery. The majority (61%, or 4,812) had localized disease. The men with locally advanced disease had more adverse features than the localized disease group, such as higher Gleason scores, more lymph node metastasis, and larger tumor volumes. The locally advanced patients also were more likely to require postoperative hormonal or radiotherapy.

Over a median follow-up of 14.3 years, men with cT3 were twice as likely as the cT2 group to have disease progression (32% vs 16%) and to die of prostate cancer (15% vs. 6%). Cancer-specific survival at 20 years' follow-up was 80% for the patients with locally advanced disease, compared with 90% for the men with localized disease. According to Mitchell, the outcomes of radical prostatectomy compare favorably with outcomes for combining external-beam radiation therapy and hormones for cT3 patients.

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