Oncological control after radical prostatectomy in men with clinical T3 prostate cancer: a single-centre experience.
OBJECTIVE
To determine the effectiveness of cancer control afforded by radical prostatectomy (RP) in patients with clinical stage T3 prostate cancer.


METHODS
We retrospectively reviewed data for patients treated by RP for clinical stage T3 prostate cancer between 1995 and 2005. The following case characteristics were analysed: patient age, clinical presentation, preoperative prostate-specific antigen (PSA) level, Gleason score, tumour stage (2002 Tumour-Node-Metastasis), surgical procedure, pathological data, margin and lymph node status, and recurrence. Biochemical recurrence was defined as an increase in PSA level of >0.2 ng/mL after surgery. Kaplan-Meier survival curves were generated, and prognostic factors were evaluated.


RESULTS
Overall, 100 patients were included; only 79% of them had pT3 disease based on the pathological specimen. The median follow-up after RP was 69 months. The RP was open in 77 and laparoscopic in 23, with no significant difference between these approaches (P = 0.38). The 5-year PSA-free survival after surgery was 45%, and 5-year cancer-specific survival was 90%. On univariable analysis, Gleason score >7 (P = 0.01), pathological stage (pT2-T3a vs T3b) (P < 0.001), positive lymph node (P < 0.001), and positive margin (P < 0.001) were associated with recurrence. On multivariable analysis, lymph node, margin status and Gleason score were also significant (P < 0.05).


CONCLUSIONS
RP can be recommended as an alternative primary treatment that results in acceptable cancer control for clinical stage T3 prostate cancer in selected cases. However, the patient should be warned that surgery alone might not be sufficient to control the cancer, and that adjuvant therapy might be needed during the course of the disease.
Xylinas
Evanguelos
E
Department of Urology, GHU EST (Pitiè-Tenon), Assistance-Publique Hôpitaux de Paris, Paris, France.
Drouin
Sarah J
SJ
Comperat
Eva
E
Vaessen
Christophe
C
Renard-Penna
Raphaële
R
Misrai
Vincent
V
Bitker
Marc-Olivier
MO
Chartier-Kastler
Emmanuel
E
Richard
François
F
Cussenot
Olivier
O
Roupret
Morgan
M
D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen