title: Long-term cancer control after radical prostatectomy and bilateral pelvic lymph node dissection for pT3bN0M0 prostate cancer in the prostate-specific antigen era.
abstract: OBJECTIVE
  We evaluated long-term cancer control outcomes of radical prostatectomy and bilateral pelvic lymph node dissection (RP) for pT3bN0M0 prostate cancer in the era of prostate-specific antigen (PSA) screening.
  
  
  METHODS
  A retrospective analysis of prospectively collected data from the University of Southern California Prostate Cancer Database was performed. Between 1987 and 2008, 229 men underwent open RP for pT3bN0M0 prostate cancer. The cohort was divided into early (1987-1997) and contemporary (1998-2008) PSA eras. The Kaplan-Meier method and Cox proportional regression models were used to analyze clinical recurrence (CR) and biochemical recurrence (BCR).
  
  
  RESULTS
  The median follow-up duration was 14.5 years (range, 0.2-21.1y). The predicted 10-year freedom from CR and BCR rates for men treated in the early and contemporary PSA eras were 73% and 95% (Log-rank P = 0.001) and 65% and 73% (Log-rank P = 0.055), respectively. Multivariable analysis showed that pathologic Gleason grade 8-10 (CR: hazard ratio [HR] = 5.11; 95% confidence interval [CI] = 1.72-15.20; P = 0.003; BCR: HR = 3.47; 95% CI = 1.60-7.48; P = 0.002) and contemporary PSA era (CR: HR = 0.15; 95% CI = 0.06-0.41; P<0.001; BCR: HR = 0.49; 95% CI = 0.28-0.86; P = 0.013) were independently associated with cancer control. Adjuvant radiation therapy and positive surgical margins were not independently associated with outcomes.
  
  
  CONCLUSIONS
  RP conferred long-term cancer control in men with pT3bN0M0 prostate cancer treated in the PSA era. Pathologic Gleason grade 8-10 and treatment in the early PSA era were independently associated with poorer cancer control outcomes.
authors.affiliation: USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Fairey
authors.affiliation: USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.affiliation: Department of Urology, Stanford University, Stanford, CA.
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.affiliation: USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
authors.forename: Anne
authors.initials: A
authors.lastname: Schuckman
authors.affiliation: USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.affiliation: USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA. Electronic address: lieskovs@usc.edu.
authors.forename: Gary
authors.initials: G
authors.lastname: Lieskovsky
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010388:Pelvis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen
keywords: Metastasis; PSA; Prostate cancer; Prostatectomy; Recurrence; Survival