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397Clinical and pathological outcome after radical prostatectomy for prostate cancer with a preoperative gleason score 8 to 10
07 EOCALISEDPROSTATEOANCER II1 Friday,18 March, 12:15-13:45;Room4.1/Hall4
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C L I N I C A L AND P A T H O L O G I C A L O U T C O M E A F T E R RADICAL PROSTATECTOMY FOR PROSTATE CANCER W I T H A PREOPERATIVE GLEASON SCORE 8 TO 10
FUNCTIONAL RESULTS AND QUALITY OF LIFE 10 YEARS AFTER RADICAL PROSTATECTOMY
Bastian E, Gonzalgo M., Freedland S., Mangold L., Partin A.
~Cliniques Universitaires Saint Lue, Dept. of Urology, Brussels, Belgium, 2Cliniques Universitaires Saint Luc, Dept. of Physiotherapy, Brussels, Belgium
The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Baltimore, United States
INTRODUCTION & OBJECTIVES: Many excellent studies have addressed specific sideeffects and quality of live (QOL) after radical prostatectomy (RP). Unfortunately, data interpretation and comparison have been hampered by the use of loose criteria or nonvalidated tools. In this study, we present actual 10 years data on fialctional results and QOL for RP patients treated in 1992 using modem criteria.
I N T R O D U C T I O N & OBJECTIVES: We sought to identify parameters predicting pathological and clinical outcome among patients with prostate cancer and a biopsy Gleason score of 8 tol0. MATERIAL & METHODS: A total of 244 patients that underwent radical prostatectomy at the Johns Hopkins Hospital who had a biopsy Gleason score of 8 to 10 were identified. We determined the significant predictors of having pathologically organ-confined disease and PSA-free survival using a logistic regressior~ analysis and a Cox proportional hazards analysis, respectively. RESULTS: In this cohort of men with biopsy Gleason sum 8-10 cancers, 186 (76%) men had cancer outside of the prostate. At 5- and 10-years after surgery, the PSA free survival was 37% (95% CI 30-44%) and 25% (95% CI 1734%). Among men with organ-confined disease and negative surgical margins, the 5- and 10-year risk of PSA free survival was 71% (95% CI 55-83%) and 40% (95% CI 17-62%). On multivariable analysis, only clinical stage T2c/T3a was statistically significantly associated with increased risk for biochemical progression. CONCLUSIONS: Men with a biopsy Gleason sum of 8 or higher were at very high-risk for advanced clinical stage and biochemical progression following RP. Even among men with organ-confined disease, the majority of men will experience a PSA recurrence. These patients are good candidates for multimodal therapy.
Tombal B. 1, Lion B. 1, Castille Y), Feyaerts A.I, OpsomerR. ~, Wese F.1, Van CmrghP.
MATERIAL & METHODS: We have updated the outcome of 169 RP patients operated during the calendar year 1992. Survivorswere contacted and asked to fill-in a validated QOL questionnaire, derived from the EORTC QLQ-PR25, which includes 29 items covering oncological status, quality of life, urinary and sexual functions. RESULTS: Mean patient's age was 64 at the time of RP and 75 by the time patients were asked to fill-in the questionnaire. Mean PSA was 15 ng/ml (95% CI: 13-17 ng/ml). Tumour stage was __pT3 in 59 cases (TNM-1997). Gleason score was >_7 in 15 patients. After 10 years, 31 patients are dead, including 12 from prostate cancer. Overall and prostate cancer specific survivals are 94 and 97% at 5 years, and 81 and 88% at 10 years respectively. Adjuvant or salvage radiation therapy has been administered in 16 and 17 patients respectively. At 10 years, there are 101 patients in remission (PSA _<0.1 ng/ml), 23 with an untreated PSA rise, 5 in remission with hormone therapy, including one with metastasis. QOL data have been collected in 89 patients and comparedwith 30 controlpatients matched for age. After I0 years, RP patients are more often incontinent than controls (p for ??: 0.007) and wear more often pads (p for y2: 0.009); 14% and 2% are still moderately or severely incontinent. Control patients complain more of nycturia than RP patients (p for ??: 0.007). We have compared incontinence rate at 10 years to incontinence rate measured six weeks and three months after RP with the adapted one hour ICS Pad Weighing Test. 53% of continent (no pad - no leak) patients at three months complain of moderate incontinence at 10 years, whereas only 15% of patients severely incontinent at 6 weeks still complain of severe incontinence after 10 years. Incontinence statistically negatively impacts overall quality of life (SpearmanR 0.336, p: 0.001). Eighty-sevenpercent of patients have no or little sexual activity, which, interestingly enough, is not statistically different from controls (86%). In this cohort of patients who underwent RP 10 years ago (mean present age 75), strongly contrasting with incontinence, erectile dysfunction does not impact overall QOL. CONCLUSIONS: QOL of live is preserved 10 years after surgery, except in a small proportion of patients with persisting severe incontinence. Erectile dysfunction however appears to be of less concem with time.
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399 RADICAL PERINEAL PROSTATECTOMY-A SINGLE INSTITUTION STUDY ON P R O S P E C T I V E L Y C O N T R O L L E D RESULTS IN A CONSECUTIVE SERIES OF 1220 CASES
O U T C O M E OF RADICAL P R O S T E C T O M Y IN PATIENTS W I T H PROSTATE CANCER AND PREOPERATIVE GLEASON SCORE > 8 Heideureich A., Ohlmann C., 0zg/ir E., Braun M., Engelmann U.
Horsch R., Jung H., GGtz T., Groh R., Neugart F. Klinikum-Offenburg, Urologische Klinik, Offenburg, Germany I N T R O D U C T I O N & O B J E C T I V E S : This report on radical perineal prostatectomy (RPP) summarizes our large experience and prospectively controlled results of this operative technique of treatment of localized prostate cancer. MATERIAL & METHODS: Between August 1995 and June 2004 1220 men underwent RPP (Young's technique) by 4 surgeons. The entire inpatient records and the follow-up results were prospectively captured. Patients with a higher risk of lymphnode metastases (< 5% Partin tables) or a Gleason sum > 3+4 were lymphadenectomized by laparoscopy(LPL) before RPE Urinary continence situation was checked by questionnaire and pad test (12 mo. po). Fecal continence was also examined by questionnaire. RESULTS: Mean age of patients was 64.3 years (41-77) and mean PSA of all men (LPL-patients incl.) was 11.Tng/ml and 8.Gng/ml respectively in men without (LPL), pathological stages: pT2 71.3%, pT3a 14.7%, pT3b 7.0%, pT4 7.0%,mean Gleason sum was 6.2, operation time 95 min.(50-197), blood loss (difference preop, hb to postop hb 5th po day) 2.1g/dl (0-6.9). There were no blood transfusions necessary in the last 723 patients. Positive margins 23.9% (pT2 13,2%), location of positive margins: urethra 14.2%, bladder neck 18.3%, apex 42.8%, lateral lobes 71.1%, urinary continence rates ( no pads) at hospital discharge 51.2% and 94.3% after 12 months, rectal lesions 2.2%, late anastomotic strictures 1.2%, passing neuropraxia 1.3%, fecal incontinence o.9%. The five years (60-92mo) disease recurrence rate (biochemical failure) was 18.8% CONCLUSIONS: Our large series demonstrates that in the hand of experienced surgeons RPP is associated with very minimal intra and postoperative morbidity. Our results suggest that RPP cannot be assumed to have greater morbidity than laparoscopic radical prostatectomy. The perineal approach is less invasive than the retropubic technique. It also entails less discomfort as well as low costs. In future patients with a high risk of positive lymphnodes will be treated by laparoscopic prostatectomy at our institution.
European Urology Supplements 4 (2005) No. 3, pp. 102
Klinikum der Universitiit zu KGln, Division of Oncological Urology, Dept. of Urology, Cologne, Germany INTRODUCTION & OBJECTIVES: Prostate cancer associated with a high Gleason score has often indicated an aggressive biological behaviour and a high rate of occult pelvic lymph node metastases. 10- and 15-year cancer specific survival rates are said to be significantly lower in patients with Gleason 8 to 10 PCA. It was the purpose of our retrospective analysis to evaluate the clinical outcome of 105 patients with high grade PCA having undergone radical prostatectomy. MATERIAL & METHODS: A total of 105 patients were identified as having pathological Gleason score 8 or greater in the radical prostatectomy specimen. 47 patients (44.8%) exhibited Gleason score 8, 54 patients (51.4%) and 4 patients (3.8%) demonstrated Gleason score 9 and I0, resp. Adjuvant endocrine treatment was administered in all patients with additional poor prognostic features such as seminal vesicle invasion (n--47, 44.7%) or lymph node metastases (n=30, 28.5%). Altogether, 77 patients (73.5%) received adjuvant hormonal therapy. Charts were reviewed retrospectively to obtain data on preoperative PSA, preoperative biopsy Gleason score, pathohistological data of the prostatectomy specimen. Progression-free, PSA-specific survival and cancer specific survival were determined by the Kaplan-Meier method. RESULTS: Median follow-up is 6.9 (0.2-10) years. Pathohistological stage distribution was pT2 in 26.5%, pT3 in 44.7% and pTxN+ in 28.5% &the patients. Positive surgical margins were achieved in 45 (42.8%). Overall survival and cancer specific survival is 85.9% and 89.5%, PSA - progression-free survival is 28%. Pathological stage (p<0.001), lymph node involvement (p<0.02) and preoperative PSA (p<0.01) were independent prognostic risk factors associated with progression-free survival. Cancerspecific and PSA-free survival in pT2 PCA is 98% and 92%, resp. 1-year continence is good with 86% requiring < lpad/day. None of the patients developed local symptoms. CONCLUSIONS: Gleason 8-10 PCA can be locally controlled with RPE in patients with organ confined disease resulting in a cancer specific survival of 98%. However, patients with pTxN+ or pT3b PCA will ultimately progress despite adjuvant hormonal therapy and these patients most probably would benefit from a more aggressive adjuvant approach. RPE remains a valuable therapeutic in high-grade prostate cancer.
397
398
C L I N I C A L AND P A T H O L O G I C A L O U T C O M E A F T E R RADICAL PROSTATECTOMY FOR PROSTATE CANCER W I T H A PREOPERATIVE GLEASON SCORE 8 TO 10
FUNCTIONAL RESULTS AND QUALITY OF LIFE 10 YEARS AFTER RADICAL PROSTATECTOMY
Bastian E, Gonzalgo M., Freedland S., Mangold L., Partin A.
~Cliniques Universitaires Saint Lue, Dept. of Urology, Brussels, Belgium, 2Cliniques Universitaires Saint Luc, Dept. of Physiotherapy, Brussels, Belgium
The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Baltimore, United States
INTRODUCTION & OBJECTIVES: Many excellent studies have addressed specific sideeffects and quality of live (QOL) after radical prostatectomy (RP). Unfortunately, data interpretation and comparison have been hampered by the use of loose criteria or nonvalidated tools. In this study, we present actual 10 years data on fialctional results and QOL for RP patients treated in 1992 using modem criteria.
I N T R O D U C T I O N & OBJECTIVES: We sought to identify parameters predicting pathological and clinical outcome among patients with prostate cancer and a biopsy Gleason score of 8 tol0. MATERIAL & METHODS: A total of 244 patients that underwent radical prostatectomy at the Johns Hopkins Hospital who had a biopsy Gleason score of 8 to 10 were identified. We determined the significant predictors of having pathologically organ-confined disease and PSA-free survival using a logistic regressior~ analysis and a Cox proportional hazards analysis, respectively. RESULTS: In this cohort of men with biopsy Gleason sum 8-10 cancers, 186 (76%) men had cancer outside of the prostate. At 5- and 10-years after surgery, the PSA free survival was 37% (95% CI 30-44%) and 25% (95% CI 1734%). Among men with organ-confined disease and negative surgical margins, the 5- and 10-year risk of PSA free survival was 71% (95% CI 55-83%) and 40% (95% CI 17-62%). On multivariable analysis, only clinical stage T2c/T3a was statistically significantly associated with increased risk for biochemical progression. CONCLUSIONS: Men with a biopsy Gleason sum of 8 or higher were at very high-risk for advanced clinical stage and biochemical progression following RP. Even among men with organ-confined disease, the majority of men will experience a PSA recurrence. These patients are good candidates for multimodal therapy.
Tombal B. 1, Lion B. 1, Castille Y), Feyaerts A.I, OpsomerR. ~, Wese F.1, Van CmrghP.
MATERIAL & METHODS: We have updated the outcome of 169 RP patients operated during the calendar year 1992. Survivorswere contacted and asked to fill-in a validated QOL questionnaire, derived from the EORTC QLQ-PR25, which includes 29 items covering oncological status, quality of life, urinary and sexual functions. RESULTS: Mean patient's age was 64 at the time of RP and 75 by the time patients were asked to fill-in the questionnaire. Mean PSA was 15 ng/ml (95% CI: 13-17 ng/ml). Tumour stage was _
400
399 RADICAL PERINEAL PROSTATECTOMY-A SINGLE INSTITUTION STUDY ON P R O S P E C T I V E L Y C O N T R O L L E D RESULTS IN A CONSECUTIVE SERIES OF 1220 CASES
O U T C O M E OF RADICAL P R O S T E C T O M Y IN PATIENTS W I T H PROSTATE CANCER AND PREOPERATIVE GLEASON SCORE > 8 Heideureich A., Ohlmann C., 0zg/ir E., Braun M., Engelmann U.
Horsch R., Jung H., GGtz T., Groh R., Neugart F. Klinikum-Offenburg, Urologische Klinik, Offenburg, Germany I N T R O D U C T I O N & O B J E C T I V E S : This report on radical perineal prostatectomy (RPP) summarizes our large experience and prospectively controlled results of this operative technique of treatment of localized prostate cancer. MATERIAL & METHODS: Between August 1995 and June 2004 1220 men underwent RPP (Young's technique) by 4 surgeons. The entire inpatient records and the follow-up results were prospectively captured. Patients with a higher risk of lymphnode metastases (< 5% Partin tables) or a Gleason sum > 3+4 were lymphadenectomized by laparoscopy(LPL) before RPE Urinary continence situation was checked by questionnaire and pad test (12 mo. po). Fecal continence was also examined by questionnaire. RESULTS: Mean age of patients was 64.3 years (41-77) and mean PSA of all men (LPL-patients incl.) was 11.Tng/ml and 8.Gng/ml respectively in men without (LPL), pathological stages: pT2 71.3%, pT3a 14.7%, pT3b 7.0%, pT4 7.0%,mean Gleason sum was 6.2, operation time 95 min.(50-197), blood loss (difference preop, hb to postop hb 5th po day) 2.1g/dl (0-6.9). There were no blood transfusions necessary in the last 723 patients. Positive margins 23.9% (pT2 13,2%), location of positive margins: urethra 14.2%, bladder neck 18.3%, apex 42.8%, lateral lobes 71.1%, urinary continence rates ( no pads) at hospital discharge 51.2% and 94.3% after 12 months, rectal lesions 2.2%, late anastomotic strictures 1.2%, passing neuropraxia 1.3%, fecal incontinence o.9%. The five years (60-92mo) disease recurrence rate (biochemical failure) was 18.8% CONCLUSIONS: Our large series demonstrates that in the hand of experienced surgeons RPP is associated with very minimal intra and postoperative morbidity. Our results suggest that RPP cannot be assumed to have greater morbidity than laparoscopic radical prostatectomy. The perineal approach is less invasive than the retropubic technique. It also entails less discomfort as well as low costs. In future patients with a high risk of positive lymphnodes will be treated by laparoscopic prostatectomy at our institution.
European Urology Supplements 4 (2005) No. 3, pp. 102
Klinikum der Universitiit zu KGln, Division of Oncological Urology, Dept. of Urology, Cologne, Germany INTRODUCTION & OBJECTIVES: Prostate cancer associated with a high Gleason score has often indicated an aggressive biological behaviour and a high rate of occult pelvic lymph node metastases. 10- and 15-year cancer specific survival rates are said to be significantly lower in patients with Gleason 8 to 10 PCA. It was the purpose of our retrospective analysis to evaluate the clinical outcome of 105 patients with high grade PCA having undergone radical prostatectomy. MATERIAL & METHODS: A total of 105 patients were identified as having pathological Gleason score 8 or greater in the radical prostatectomy specimen. 47 patients (44.8%) exhibited Gleason score 8, 54 patients (51.4%) and 4 patients (3.8%) demonstrated Gleason score 9 and I0, resp. Adjuvant endocrine treatment was administered in all patients with additional poor prognostic features such as seminal vesicle invasion (n--47, 44.7%) or lymph node metastases (n=30, 28.5%). Altogether, 77 patients (73.5%) received adjuvant hormonal therapy. Charts were reviewed retrospectively to obtain data on preoperative PSA, preoperative biopsy Gleason score, pathohistological data of the prostatectomy specimen. Progression-free, PSA-specific survival and cancer specific survival were determined by the Kaplan-Meier method. RESULTS: Median follow-up is 6.9 (0.2-10) years. Pathohistological stage distribution was pT2 in 26.5%, pT3 in 44.7% and pTxN+ in 28.5% &the patients. Positive surgical margins were achieved in 45 (42.8%). Overall survival and cancer specific survival is 85.9% and 89.5%, PSA - progression-free survival is 28%. Pathological stage (p<0.001), lymph node involvement (p<0.02) and preoperative PSA (p<0.01) were independent prognostic risk factors associated with progression-free survival. Cancerspecific and PSA-free survival in pT2 PCA is 98% and 92%, resp. 1-year continence is good with 86% requiring < lpad/day. None of the patients developed local symptoms. CONCLUSIONS: Gleason 8-10 PCA can be locally controlled with RPE in patients with organ confined disease resulting in a cancer specific survival of 98%. However, patients with pTxN+ or pT3b PCA will ultimately progress despite adjuvant hormonal therapy and these patients most probably would benefit from a more aggressive adjuvant approach. RPE remains a valuable therapeutic in high-grade prostate cancer.