title: Long-term oncological outcome and risk stratification in men with high-risk prostate cancer treated with radical prostatectomy.
abstract: OBJECTIVE
  To evaluate the long-term oncological outcome of radical prostatectomy for patients with high-risk prostate cancer.
  
  
  METHODS
  Among 378 patients with prostate cancer who underwent radical prostatectomy at our hospital, 189 had high-risk prostate cancer defined as presenting with at least one of the following high-risk factors: prostate-specific antigen >20 ng/ml, clinical T3 and biopsy Gleason score ≥8.
  
  
  RESULTS
  The median follow-up was 8.1 years. Of all patients, 106 and 61 had one and two high-risk factors, respectively, and the remaining 22 had all three high-risk factors. Pathological examination of the prostatectomy specimens revealed organ-confined disease, specimen-confined disease and lymph node metastasis in 80 (42%), 102 (54%) and 22 (12%), respectively. The 10-year prostate-specific antigen failure-free and local progression-free survival rates were 48.5 and 87.6%, respectively. The 10-year cancer-specific and overall survival rates were 94.1 and 88.7%, respectively. The 10-year prostate-specific antigen failure-free survivals of patients with one, two and all three high-risk factors were 58.5, 39.9 and 22.7%, respectively (P = 0.0001). Of the 106 patients with one high-risk factor only, the high Gleason score group had the best 10-year prostate-specific antigen failure-free survival (69.1%); in particular, that of patients without Gleason grade 5 was 100% (P= 0.032).
  
  
  CONCLUSIONS
  Approximately half of patients with high-risk prostate cancer can be cured by radical prostatectomy without any adjuvant treatment. Radical prostatectomy for high-risk prostate cancer provides good long-term local cancer control and cancer-specific survival. In particular, radical prostatectomy for patients with only one high-risk factor can be considered a valuable therapeutic option as the first treatment.
authors.affiliation: Department of Urology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, Japan. shinya.yamamoto@jfcr.or.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Junji
authors.initials: J
authors.lastname: Yonese
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Shinji
authors.initials: S
authors.lastname: Urakami
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Noboru
authors.initials: N
authors.lastname: Numao
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kohno
authors.forename: Iwao
authors.initials: I
authors.lastname: Fukui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen