Radical prostatectomy in high-risk prostate cancer: incidence of specimen-confined disease (pT2-pT3a N0R0) and outcomes.
BACKGROUND
Radical prostatectomy (RP) in patients with high-risk prostate cancer (PC) [prostate specific antigen (PSA) ≥ 20 ng/mL, and/or Gleason score ≥ 8, and/or cT3a disease] is considered an optional therapy, usually as a part of multimodal approach. Aim of the study is to evaluate the outcome of radical prostatectomy in case of specimen-confined (SC) disease and to compare it with patients with pathological locally-advanced disease.


METHODS
Data from 176 consecutive patients with high-risk prostate cancer who underwent RP as initial therapy were analyzed, identifying subjects with specimen-confined disease (i.e. negative margins and negative lymph-nodes) in which RP was considered as monotherapy, and comparing oncological outcomes to patients with pathological non-SC disease, in which RP was considered as the first step of a multimodal approach.


RESULTS
In high-risk prostate cancer, pathological report showed the presence of specimen-confined disease in 28.3% of cases. At univariate analysis, age and PSA correlate with the presence of SC disease at radical prostatectomy, while at multivariate analysis only PSA was a significant predictor of SC disease. At 5 years, Kaplan-Meier estimation of biochemical-free and cancer-specific survival was 56.2% and 97.7% vs 40.8% and 92.8% in specimen-confined disease and non-specimen-confined disease, respectively.


CONCLUSIONS
High-risk prostate cancer presents challenges for uro-oncologists since standard treatment is still under debate. One third of patients will present with specimen-confined disease, for which radical prostatectomy represents the sole, initial curative therapy; RP as multimodal therapy in patients without SC disease permits excellent long-term oncological outcomes.
Urology Department, University of Perugia, Perugia - Italy.
Luigi
L
Mearini
Elisabetta
E
Nunzi
Vittorio
V
Bini
Luca
L
Lepri
Raffaella
R
Bruno
Massimo
M
Porena
D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011877:Radionuclide Imaging; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome