Long-Term Outcome of Patients with High-Risk Prostate Cancer following Radical Prostatectomy and Stage-Dependent Adjuvant Androgen Deprivation

Abstract

Purpose: To present the long-term outcome of high-risk prostate cancer patients treated by radical retropubic prostatectomy (RRP) and stage-dependent adjuvant androgen deprivation therapy. Patients and Methods: Between 1989 and 2005, 2,655 patients underwent RRP by 9 surgeons. All cases (n = 372) with high-risk prostate cancer (serum PSA >20 ng/ml, and/or clinical stage T2c or greater, and/or biopsy Gleason score 8 or greater) were identified and analyzed retrospectively. Results: At 5 and 10 years, cancer-specific survival was 91.3 and 87.2%; overall survival was 84.3 and 72.1%; biochemical progression-free survival (BPFS) was 76.6 and 56.2%; clinical progression-free survival was 86.2 and 79.9%. Kaplan-Meier analysis showed significant differences with respect to pathological stage and Gleason score for cancer-specific survival, BPFS and clinical progression-free survival. In multiple analysis, the only preoperative predictor of BPFS at the 5% level was clinical stage (p = 0.0055). Conclusion: In patients with high-risk prostate cancer and a life expectancy of more than 10 years, RRP with stage-dependent adjuvant androgen deprivation therapy is a viable alternative to radiation therapy.

An Age Adjusted Comorbidity Index to Predict Long-Term, Other Cause Mortality in Men with Prostate Cancer

“…22 Multimodal intervention with surgery with or without adjuvant radiation therapy has shown great promise for such tumors, decreasing cancer specific mortality to 8% to 13% at 10 years. 23,24 Such a tradeoff may be worth the risk of the morbidity of aggressive treatment even in the face of a moderate risk of other cause mortality. Therefore, we advocate using tumor risk and life expectancy to triage treatment at the time of the treatment decision and not before diagnosis.…”

Impact of 68Ga-PSMA PET/CT on salvage radiotherapy planning in patients with prostate cancer and persisting PSA values or biochemical relapse after prostatectomy

“…Approximately one third to one half of patients suffer from biochemical relapse (BCR) within 5–10 years after primary curative prostatectomy or radiotherapy (RT) [2–4]. Salvage radiotherapy (SRT) is recommended in patients treated with radical prostatectomy who experience BCR without distant metastases [5, 6].…”

Predictive Value of Positive Surgical Margins after Radical Prostatectomy for Lymph Node Metastasis in Locally Advanced Prostate Carcinoma

“…The median Gleason score from the prostate biopsy was 8 (range 6–10) and from the prostatectomy specimen 9 [7–9]. Only in 44% Gleason score of prostate biopsy and specimen was identical; underestimation in prostate biopsy score of one to three points was detected in 41% of patients and overestimation of one score point in 15%.…”

“…Using the same series, Gontero et al found that the PSA level was of prognostic relevance with 26% cured by surgery alone when PSA was 20–50 ng/mL but only about 7–9% with PSA >50 ng/mL [8]. A single-centre analysis of more than 2 600 patients with locally advanced prostate cancer after RP and adjuvant androgen deprivation revealed the Gleason score to be the most important prognostic factor [9]. In our much smaller series we did not attempt to show cancer-specific survival, but for the prediction of T stage and lymph node involvement, the Gleason score was not the most obvious parameter.…”