title: Outcome predictors of radical cystectomy in patients with cT4 prostate cancer: a multi-institutional study of 62 patients.
abstract: To identify which patients with macroscopic bladder-infiltrating T4 prostate cancer (PCa) might have favourable outcomes when treated with radical cystectomy (RC).
  
  
  
  We evaluated 62 patients with cT4cN0-1 cM0 PCa treated with RC and pelvic lymph node dissection between 1972 and 2011. In addition to descriptive statistics, the Kaplan-Meier method and log-rank tests were used to depict survival rates. Univariate and multivariate Cox regression analysis tested the association between predictors and progression-free, PCa-specific and overall survival.
  
  
  
  Of the 62 patients, 19 (30.6%) did not have clinical progression during follow-up, two (3.2%) had local recurrence, and 32 (51.6%) had haematogenous and nine (14.5%) combined pelvic and distant metastasis. Forty patients (64.5%) died, 34 (54.8%) from PCa and six (9.7%) from other causes. The median (range) survival time of the 19 patients who were metastasis-free at last follow-up was 86 (1-314) months, 8/19 patients had a follow-up of >5 years, and five patients survived metastasis-free for >15 years. Patients without seminal vesicle invasion (SVI) had the best outcomes, with an estimated 10-year PCa-specific survival of 75% compared with 24% for patients with SVI.
  
  
  
  For cT4 PCa RC can be an appropriate treatment for local control and part of a multimodality-treatment approach. Although recurrences are probable, these do not necessarily translate into cancer-specific death. Men without SVI had a 75% 10-year PCa-specific survival. Although outcomes for patients with SVI are not as favourable, there can be good local control; however, these patients are at higher risk of progression and may need more aggressive systemic treatment.
authors.affiliation: Department of Urology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Spahn
authors.affiliation: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morlacco
authors.affiliation: Department of Urology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Silvan
authors.initials: S
authors.lastname: Boxler
authors.affiliation: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Vita Salute University, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, University of Turin, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.affiliation: Department of Urology, Community Hospital Karlsruhe, Karlsruhe, Germany.
authors.forename: Pia
authors.initials: P
authors.lastname: Bader
authors.affiliation: Department of Urology, Community Hospital Karlsruhe, Karlsruhe, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Frohneberg
authors.affiliation: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Hein
authors.initials: H
authors.lastname: van Poppel
authors.affiliation: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN, USA.
authors.forename: Robert Jeffrey
authors.initials: RJ
authors.lastname: Karnes
mesh_terms: D000368:Aged; D015653:Cystectomy; D018450:Disease Progression; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D012669:Seminal Vesicles / Q000000981:diagnostic imaging / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000556:secondary* / Q000601:surgery* / Q000628:therapy
chemical_list: D017430:Prostate-Specific Antigen
keywords: #PCSM; #ProstateCancer; #uroonc; cystectomy; high-risk prostate cancer; locally advanced prostate cancer; multimodality treatment; surgery