527 Oncologic Control After Radical Prostatectomy in Men With Clinical T3 Prostate Cancer: A Single-Center Experience

Xylinas, E.; Drouin, S.; Comperat, Eva; Vaessen, C.; Renard-Penna, R.; Misraï, Vincent; Mo, Bitker; Chartier-Kastler, E.; Richard, Françoise; Cussenot, Olivier; Rouprêt, Morgan

doi:10.1016/s1569-9056(09)60523-6

Cited by 3 publications

(8 citation statements)

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“…The occurrence of the major postoperative functional complications, such as urinary incontinence and erectile dysfunction, is almost similar to those complications observed from surgery with a radical technique involving organ‐confined tumours [4,5]. Nevertheless, the effectiveness of local tumour control after RP for cT3 prostate cancer remains the focus of debate and is highly controversial [6–9]. These issues are particularly important for patients with locally advanced prostate cancer, because they are at high risk of symptomatic progression.…”

Section: Introductionmentioning

confidence: 83%

“…The progression of the disease to seminal vesicles, regional lymph node metastases, positive surgical margins and a high level of serum PSA account for independent prognostic factors of biochemical recurrence. The positive surgical margin rate varied from 22 to 61%[4–9]. These results were higher in cases involving intracapsular tumours.…”

Section: Oncological Outcomesmentioning

confidence: 93%

“…The global survival rates at 5, 10 and 15 years range from 78 to 96%, 63 to 77% and ≥50% of patients, respectively. The biochemical‐free survival rate (PSA <0.2 ng/mL) at 5, 10 and 15 years ranges from 45 to 62%, 43 to 51% and 15 to 49%, respectively [4–9]. However, the results of these series are not comparable because of their lack of homogeneity.…”

Section: Oncological Outcomesmentioning

confidence: 99%

“…The rectal examination’s specificity for the diagnosis of prostate cancer is close to 50%[10]. In operated cT3 prostate cancers, the over‐assessed cancer rate (corresponding to pT2a and/or pT2b in reality) fluctuates between 9 and 27% according to recent series [4–9]. On the other hand, the under‐assessed cancer rate (normal rectal examination corresponding to a pT3 cancer in reality) is more difficult to estimate.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

“…A MEDLINE search was performed with special emphasis on clinical T3 prostate cancer (cT3) treated by surgical procedures using combinations of the following terms: prostate cancer; digital rectal examination; surgical margins; T3; radical prostatectomy; PSA; prognosis; recurrence. We report all published series of men who underwent RP for cT3 disease, with the aim of assessing the cancer control afforded by RP in this particular population of patients [4–9].…”

Section: Introductionmentioning

confidence: 99%

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Is radical prostatectomy a viable therapeutic option in clinically locally advanced (cT3) prostate cancer?

2010

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According to the literature, the current preferred treatment for T3 prostate cancer is a combination of radiotherapy and extended hormone therapy. The preoperative staging based on digital rectal examination results alone now appears obsolete from the investigated series, in which 20% of T3 prostate cancer is over‐staged during physical examination. Prostatic magnetic resonance imaging is becoming increasingly necessary to evaluate extraprostatic extension during the preoperative evaluation. European Association of Urology guidelines recommend the use of radical prostatectomy only in selected patients with cT3a who have a PSA <20 ng/mL and a biopsy Gleason score ≤8. The cancer control obtained after the implementation of radical prostatectomy is variable from one series to another, with PSA‐free survival rates at 5, 10 and 15 years ranging from 45 to 62%, 43 to 51% and 15 to 49%, respectively. The specific survival rates at 5, 10 and 15 years are between 84 and 98%, 84 and 91% and 76 and 84%, respectively. The surgical margins rate varies from 22% to 61% depending on the specific operative technique used and the surgeon’s own experience level. Regarding urinary continence, functional outcomes are in line with those of prostatectomy for localized prostate cancer. Upon consideration of erectile dysfunction, the rates are linked with the type of surgery performed, which can at times be fairly extensive. There is no impact on the overall or specific survival rate of neoadjuvant treatments. One of the problems currently depends on the efficacy of early adjuvant treatment after prostatectomy, especially regarding the use of adjuvant external beam radiotherapy. Radical prostatectomy can be considered in selected cases as a viable alternative to the first‐line treatment option. However, patients must be counselled that they may undergo complementary treatments during the postoperative course of the disease.

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Section: Introductionmentioning

confidence: 83%

Section: Oncological Outcomesmentioning

confidence: 93%

Section: Oncological Outcomesmentioning

confidence: 99%

Section: Preoperative Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is radical prostatectomy a viable therapeutic option in clinically locally advanced (cT3) prostate cancer?

2010

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Résultats carcinologiques et fonctionnels de la prostatectomie totale dans les cancers de la prostate T3

Xylinas

Misraï

Compérat

et al. 2009

Progrès en Urologie

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Oncological outcomes of cryosurgery as primary treatment in T3 prostate cancer: experience of a single centre

Zhi

Yang

et al. 2015

BJU International

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ObjectiveTo assess the oncological outcomes and determine prognostic factors for overall survival (OS), cancer-specific survival (CSS), and biochemical progression-free survival (BPFS) after cryosurgery for clinical stage T3 prostate cancer. Patients and MethodsBetween 2002 and 2007, 75 patients with clinical stage T3 prostate cancer received cryosurgery as primary treatment in our institution. No adjuvant treatment was provided until biochemical failure. After biochemical failure, hormone therapy was administered. Kaplan-Meier analysis was used to calculate the OS, CSS, and BPFS. Cox regression was used to identify factors predictive of survival. ResultsClinical stage T3a (cT3a) was detected in 60% (45/75) of patients and cT3b detected in 40% (30/75). The 5-year OS, CSS, and BPFS rates were 85.3%, 92.0%, and 48%, respectively. There was a significant difference when comparing the pT3a with the pT3b group for 5-year OS (88.9% vs 80%, P = 0.02) and BPFS (55.6% vs 36.7%, P = 0.01), but there was no difference in CSS (93.3% vs 90%, P = 0.63). Stage, Gleason score, and nadir prostate-specific antigen (PSA) were associated with BPFS, while Gleason score and nadir PSA were the most significant predictors for CSS. ConclusionsCryosurgery can offer good 5-year OS, CSS, and BPFS rates for cT3 prostate cancer, and there was no difference between T3a and T3b for CSS. Gleason score and nadir PSA were the most significant predictors of survival. Further clinical trials are warranted for evaluating the role of cryosurgery for cT3 prostate cancer.

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527 Oncologic Control After Radical Prostatectomy in Men With Clinical T3 Prostate Cancer: A Single-Center Experience

Cited by 3 publications

References 0 publications

Is radical prostatectomy a viable therapeutic option in clinically locally advanced (cT3) prostate cancer?

Is radical prostatectomy a viable therapeutic option in clinically locally advanced (cT3) prostate cancer?

Résultats carcinologiques et fonctionnels de la prostatectomie totale dans les cancers de la prostate T3

Oncological outcomes of cryosurgery as primary treatment in T3 prostate cancer: experience of a single centre

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