title: 20-Year survival after radical prostatectomy as initial treatment for cT3 prostate cancer.
abstract: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Despite a lack of randomised controlled trials, most men with locally advanced prostate cancer are recommended to undergo external beam radiotherapy (EBRT), often combined with long-term androgen-deprivation therapy (ADT). Many of these men are not offered radical prostatectomy (RP) by their treating urologist. Additionally, it is know that EBRT with long-term ADT does provide good cancer control (88% at 10 years). We have previously published intermediate-term follow-up of a large series of men treatment with RP for cT3 prostate cancer. We report long-term follow-up of a large series of men treated with RP as primary treatment for cT3 prostate cancer. Our study shows that with long-term follow-up RP provides excellent oncological outcomes even at 20 years. While most men do require a multimodal treatment approach, many men can be managed successfully with RP alone.
  
  
  OBJECTIVE
  • To present long-term survival outcomes after radical prostatectomy (RP) for patients with cT3 prostate cancer, as the optimal treatment for patients with clinical T3 prostate cancer is debated.
  
  
  METHODS
  • We identified 843 men who underwent RP for cT3 tumours between 1987 and 1997. • Survival was estimated using the Kaplan-Meier method. • Cox proportional hazards regression models were used to evaluate the association of clinicopathological features with outcome
  
  
  RESULTS
  • The median (range) postoperative follow-up was 14.3 (0.1-23.5) years. • Down-staging to pT2 disease occurred in 26% (223/843) at surgery. • Local recurrence-free, systemic progression-free and cancer-specific survival for men with cT3 prostate cancer after RP was 76%, 72%, and 81%, respectively, at 20 years. • On multivariate analysis, increasing RP Gleason score (hazard ratio [HR] 1.8; P = 0.01), non-diploid chromatin content (HR 1.8; P = 0.01), positive surgical margins (HR 2.1; P = 0.007), and seminal vesicle invasion (HR 2.1; P = 0.005) were associated with a significant risk of prostate cancer death, while a more recent year of surgery was associated with a decreased risk of cancer-specific mortality (HR 0.88; P = 0.01)
  
  
  CONCLUSIONS
  • RP affords accurate pathological staging and may be associated with durable cancer control for cT3 prostate cancer, with 20 years of follow-up presented here. • RP as part of a multimodal treatment strategy therefore remains a viable treatment option for patients with cT3 tumours.
authors.affiliation: Departments of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mitchell
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Eric C
authors.initials: EC
authors.lastname: Umbreit
authors.forename: Laureano J
authors.initials: LJ
authors.lastname: Rangel
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Carlson
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
mesh_terms: D000368:Aged; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D011182:Postoperative Care / Q000401:mortality; D011468:Prostatectomy / Q000379:methods / Q000401:mortality*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome