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Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer
Urologic Oncology: Seminars and Original Investigations 25 (2007) 87–95
Urologic Oncology Survey CLINICAL RESEARCH Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer. Carver BS, Bianco FJ Jr, Scardino PT, Eastham JA, Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY. J Urol 2006;176:564 – 8 Purpose: We evaluated patients at our institution who underwent radical prostatectomy for clinical stage T3 prostate cancer to determine their long-term clinical outcomes. Materials and Methods: We reviewed our prospective surgical database and identified 176 men who underwent radical retropubic prostatectomy for clinical stage T3 prostate cancer from 1983 to 2003. Clinical and pathological data were reviewed and evaluated in a Cox proportional hazards model to determine preoperative predictors of biochemical recurrence. Clinical progression following biochemical recurrence was evaluated and clinical failure was defined as the development of clinical metastases or progression to hormone refractory prostate cancer. Results: Of the 176 patients with cT3 prostate cancer 64 (36%) received neoadjuvant hormonal therapy. At a mean followup of 6.4 years 84 (48%) patients had disease recurrence with a median time to biochemical recurrence of 4.6 years. The actuarial 10-year probability of freedom from recurrence was 44%. On multivariate analysis biopsy Gleason score, pretreatment serum prostate specific antigen and year of surgery were independent predictors of biochemical recurrence. Neoadjuvant hormonal therapy was not a significant predictor of biochemical recurrence. Following biochemical recurrence clinical failure developed in 30 of 84 (36%) men with a median time of 11 years. Overall the 5, 10 and 15-year probabilities of death from prostate cancer were 6%, 15% and 24%, respectively. Conclusions: More than half (52%) of our patients remained free of disease recurrence following radical prostatectomy. In our series neoadjuvant hormonal therapy offered no advantage with respect to disease recurrence. Radical prostatectomy remains an integral component in the treatment of select patients with clinical stage T3 prostate cancer.
Commentary Historically, radical prostatectomy has been considered appropriate for men with clinically localized carcinoma of the prostate. It has long been recognized that men with microscopic, pathologic stage T3 disease may be cured with radical prostatectomy, but surgery often has been withheld in men with clinical T3 cancers. This is changing. There are 2 dominant considerations that may lead to a change in treatment strategy for men with clinical stage T3 cancer. First of all, as the authors of this article show, almost half of these men can achieve long-term disease-free survival with surgery. Furthermore, even those patients not completely cured with surgery may benefit from surgical debulking. The highly reduced morbidity of radical prostatectomy makes it more acceptable as a method for prevention of potential future local problems from tumor growth. In addition, treatment strategies, including postoperative irradiation or adjuvant hormonal therapy, can be used as part of a multimodal treatment strategy in men with locally advanced tumors. Undoubtedly, many prostate cancers are overtreated with radical prostatectomy. At the other end of the spectrum, though, treatment has often not been sufficiently aggressive for locally advanced tumors. Radical prostatectomy likely will assume an increasingly important role in the treatment of these patients. doi:10.1016/j.urolonc.2006.10.006 Joseph A. Smith, M.D. Long-term followup of a randomized study of locally advanced prostate cancer treated with combined orchiectomy and external radiotherapy versus radiotherapy alone. Granfors T, Modig H, Damber JE, Tomic R, Department of Urology, Central Hospital, Vasteras, Sweden. J Urol 2006;176:544 –7 Purpose: In a randomized study we compared the combination of orchiectomy and radiotherapy to radiotherapy alone as treatment for locally advanced prostate cancer. Patients who were treated only with radiotherapy initially underwent castration therapy at clinical progression, providing the opportunity to compare immediate vs deferred endocrine intervention. 1078-1439/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved.
Urologic Oncology Survey CLINICAL RESEARCH Long-term outcome following radical prostatectomy in men with clinical stage T3 prostate cancer. Carver BS, Bianco FJ Jr, Scardino PT, Eastham JA, Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY. J Urol 2006;176:564 – 8 Purpose: We evaluated patients at our institution who underwent radical prostatectomy for clinical stage T3 prostate cancer to determine their long-term clinical outcomes. Materials and Methods: We reviewed our prospective surgical database and identified 176 men who underwent radical retropubic prostatectomy for clinical stage T3 prostate cancer from 1983 to 2003. Clinical and pathological data were reviewed and evaluated in a Cox proportional hazards model to determine preoperative predictors of biochemical recurrence. Clinical progression following biochemical recurrence was evaluated and clinical failure was defined as the development of clinical metastases or progression to hormone refractory prostate cancer. Results: Of the 176 patients with cT3 prostate cancer 64 (36%) received neoadjuvant hormonal therapy. At a mean followup of 6.4 years 84 (48%) patients had disease recurrence with a median time to biochemical recurrence of 4.6 years. The actuarial 10-year probability of freedom from recurrence was 44%. On multivariate analysis biopsy Gleason score, pretreatment serum prostate specific antigen and year of surgery were independent predictors of biochemical recurrence. Neoadjuvant hormonal therapy was not a significant predictor of biochemical recurrence. Following biochemical recurrence clinical failure developed in 30 of 84 (36%) men with a median time of 11 years. Overall the 5, 10 and 15-year probabilities of death from prostate cancer were 6%, 15% and 24%, respectively. Conclusions: More than half (52%) of our patients remained free of disease recurrence following radical prostatectomy. In our series neoadjuvant hormonal therapy offered no advantage with respect to disease recurrence. Radical prostatectomy remains an integral component in the treatment of select patients with clinical stage T3 prostate cancer.
Commentary Historically, radical prostatectomy has been considered appropriate for men with clinically localized carcinoma of the prostate. It has long been recognized that men with microscopic, pathologic stage T3 disease may be cured with radical prostatectomy, but surgery often has been withheld in men with clinical T3 cancers. This is changing. There are 2 dominant considerations that may lead to a change in treatment strategy for men with clinical stage T3 cancer. First of all, as the authors of this article show, almost half of these men can achieve long-term disease-free survival with surgery. Furthermore, even those patients not completely cured with surgery may benefit from surgical debulking. The highly reduced morbidity of radical prostatectomy makes it more acceptable as a method for prevention of potential future local problems from tumor growth. In addition, treatment strategies, including postoperative irradiation or adjuvant hormonal therapy, can be used as part of a multimodal treatment strategy in men with locally advanced tumors. Undoubtedly, many prostate cancers are overtreated with radical prostatectomy. At the other end of the spectrum, though, treatment has often not been sufficiently aggressive for locally advanced tumors. Radical prostatectomy likely will assume an increasingly important role in the treatment of these patients. doi:10.1016/j.urolonc.2006.10.006 Joseph A. Smith, M.D. Long-term followup of a randomized study of locally advanced prostate cancer treated with combined orchiectomy and external radiotherapy versus radiotherapy alone. Granfors T, Modig H, Damber JE, Tomic R, Department of Urology, Central Hospital, Vasteras, Sweden. J Urol 2006;176:544 –7 Purpose: In a randomized study we compared the combination of orchiectomy and radiotherapy to radiotherapy alone as treatment for locally advanced prostate cancer. Patients who were treated only with radiotherapy initially underwent castration therapy at clinical progression, providing the opportunity to compare immediate vs deferred endocrine intervention. 1078-1439/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved.