[Carcinologic outcomes after radical prostatectomy in 81 high-risk patients].
OBJECTIVE
To evaluate carcinologic outcomes and biologic recurrence (BR) factor after radical prostatectomy (RP) for high-risk (HR) prostate cancer.


METHODS
Between 1996 and 2006, 81 consecutives RP (65 with standard lymphadenectomy) have been done by a single surgeon for HR cancer according to d'Amico classification. No patient received neo-adjuvant therapy. Minimum follow-up required was 2 years. The BR was defined by two consecutives PSA greater than 0.2 ng/ml. Forty patients required immediate adjuvant therapy. Thirty for patients required secondary therapy. A multivariate analysis have been done for the following factors: age at RP, TNM stage, pre- and postoperative PSA, Gleason score, number of positive core biopsy, number of HR factor, positive surgical margin and immediate adjuvant therapy.


RESULTS
Mean age was 64 years. Median follow-up was 71 month. Forty-nine patients was pT3 (60.5 %), seven was pN+(8.7 %) and 40 had positive surgical margin (49.4 %). The 5 years biological recurrence free survival rate was 42 %. The Gleason score (p=0.003, RR=1.688, IC=1.193-2.387), the preoperative PSA (p=0.001, RR=1.06, IC=1.032-1.089) and the number of positive core biopsy (p=0.006, RR=5.316, IC=1.605-17.607) were significant independent prognostic factors for the BR. The number of HR factor, positive surgical margin and immediate adjuvant therapy were not significant independent prognostic factors for the BR.


CONCLUSIONS
At 5 years, RP in HR prostate cancer allowed carcinologic control without BR in 34 patients (42 %). This result was not influenced by the number of HR factor, surgical positive margin and immediate adjuvant therapy.
Carcenac
A
A
Service d'urologie, CHU du Nord-de-Marseille, chemin des Bourrely, Marseille, France. Aurelien.Carcenac@ap-hm.fr
Arroua
F
F
Gaudart
J
J
Ragni
E
E
Rossi
D
D
Bastide
C
C
D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome