title: Tailored treatment including radical prostatectomy and radiation therapy + androgen deprivation therapy versus exclusive radical prostatectomy in high-risk prostate cancer patients: results from a prospective study.
abstract: OBJECTIVE
  To evaluate outcomes of patients with high risk prostate cancer (PCa) who underwent radical prostatectomy (RP) in a context of a multidisciplinary approach including adjuvant radiation (RT) + androgen deprivation therapy (ADT).
  
  
  METHODS
  244 consecutive patients with high risk localized PCa underwent RP and bilateral extended pelvic lymph node dissection at our institution. Adjuvant RT + 24 months ADT was carried out in subjects with pathological stage ≥ T3N0 and/or positive surgical margins or in patients with local relapse.
  
  
  RESULTS
  After a median follow-up was 54.17 months (range 5.4-117.16), 13 (5.3%) subjects had biochemical progression, 21 (8.6%) had clinical progression, 7 (2.9%) died due to prostate cancer and 15 (6.1%) died due to other causes. 136 (55.7%) patients did not receive any adjuvant treatment while 108 (44.3%) received respectively adjuvant or salvage RT+ADT. Multivariate Cox proportional hazard analysis showed that pre-operative PSA value at diagnosis is a significant predictive factor for BCR (HR: 1.04, p < 0.05) and that Gleason Score 8-10 (HR: 2.4; p < 0.05) and PSMs (HR: 2.01; p < 0.01) were significant predictors for clinical progression. Radical prostatectomy group was associated with BPFS, CPFS, CSS and OS at 5-years of 97%, 90%, 95% and 86% respectively, while adjuvant radiation + androgen deprivation therapy group was associated with a BPFS, CPFS and CSS at 5-years of 91%, 83%, 95% and 88%, without any statistical difference.
  
  
  CONCLUSIONS
  Multimodality tailored treatment based on RP and adjuvant therapy with RT+ADT achieve similar results in terms of OS after 5-years of follow-up.
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Castelli
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Giorgio Ivan
authors.initials: GI
authors.lastname: Russo
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Favilla
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Urzi
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Spitaleri
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Reale
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Raimondo
authors.initials: R
authors.lastname: Giardina
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Saita
authors.affiliation: Department of Urology, University of Sassari, Sassari, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Madonia
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cimino
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen