title: Radical prostatectomy for cT3-4 disease: an evaluation of the pathological outcomes and patterns of care for adjuvant radiation in a national cohort.
abstract: OBJECTIVE
  • To use the Surveillance, Epidemiology and End Results Database to evaluate the pathological outcomes for patients with clinically staged T3-4 disease who undergo radical prostatectomy and to analyze whether these patients are receiving adjuvant radiation.
  
  
  METHODS
  • We identified patients who were clinically staged as having T3-4N0M0 prostate cancer and underwent radical prostatectomy between 2004 and 2006. Clinical data regarding preoperative prostate-specific antigen, as well as pathological Gleason score, were also collected. • Descriptive analyses were performed regarding the pathological extent of disease for these patients. • Logistic regression analysis was performed to identify unadjusted and adjusted predictors of radiation use for those with non-organ-confined disease or positive margins.
  
  
  RESULTS
  • A total of 718 patients were identified. Of these, 10.2% had organ-confined disease (8.1% with negative margins and 2.1% with positive margins). The median number of lymph nodes removed was three, with 9.9% of patients having pathologically positive lymph nodes. • The clinical accuracy of staging was found to be 81.4% for T3a, 77.4% for T3b and 70.1% for T4. Of those who had non-organ-confined disease or positive margins pathologically, 21.1% received adjuvant radiation. Logistic regression analysis revealed that those with Gleason 8-10 disease were most likely to receive adjuvant radiation.
  
  
  CONCLUSIONS
  • In this large series from a population-based cohort, clinical staging of T3-T4 disease was highly accurate in predicting pathological extent, with only 10.2% of patients found to have pathological T2 disease. • Most patients with confirmed pathological T3-T4 disease did not receive adjuvant radiation.
authors.affiliation: Department of Radiation Oncology, State University of New York-Downstate, Brooklyn, NY 11209, USA. david.schreiber@downstate.edu
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
authors.forename: Justin
authors.initials: J
authors.lastname: Rineer
authors.forename: Sonal
authors.initials: S
authors.lastname: Sura
authors.forename: Ervin
authors.initials: E
authors.lastname: Teper
authors.forename: Tom
authors.initials: T
authors.lastname: Nabhani
authors.forename: Peter
authors.initials: P
authors.lastname: Han
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.forename: Kwang
authors.initials: K
authors.lastname: Choi
authors.forename: Marvin
authors.initials: M
authors.lastname: Rotman
mesh_terms: D015331:Cohort Studies; D006801:Humans; D007430:Intraoperative Care / Q000592:standards; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012042:Registries; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen