Oncologic Outcome of Radical Prostatectomy as Monotherapy for Men with High-risk Prostate Cancer

Abstract

Background: The objective of this study was to review our experience with radical prostatectomy (RP) as monotherapy for men with high-risk prostate cancer (PCa). Patients and Methods: This study included 382 consecutive patients who were diagnosed with high-risk PCa according to the D'Amico definition and subsequently underwent RP without neoadjuvant therapy. Biochemical recurrence (BR) was defined as a serum prostate-specific antigen (PSA) level ≥ 0.2 ng/ml on two consecutive measurements, and none of the patients received any adjuvant therapies until their serum PSA levels reached ≥ 0.4 ng/ml. Results: The median preoperative serum PSA level in these 382 patients was 15.9 ng/ml. Pathological stages ≥ pT2c and Gleason scores ≥ 8 were observed in 288 and 194 patients, respectively. During the observation period (median, 48.0 months), BR occurred in 134 patients, and the 5-year BR-free survival rate was 60.1%; however, no patient died of cancer progression. Multivariate analysis identified capsular invasion, seminal vesicle invasion, and surgical margin status as independent predictors of BR. clusions: Comparatively favorable cancer control could be achieved using RP as monotherapy for men with high-risk PCa; however, RP alone may be insufficient for patients with capsular invasion, seminal vesicle invasion, and/or surgical margin positivity.

Short Term Outcomes in Indian Patients with High Risk Prostate Cancer after Laparoscopic Radical Prostatectomy- Data from a Single Institute

“…Similarly the distribution of biopsy GS was variable. A score below 8 in more than half of the cases was reported by few authors [11,14,16,18,19]; while a score of 8 or more was noted by others, including us [5,10,17]. However, patient's clinical stage in our study was similar to the other reports.…”

“…More than two third (68.6%) of our patients had T3 pathological stage, unlike the near equal representation of pT2 and pT3 in other reports [5,15,19,17] (Table 5). Specimen GS of our patients was also higher (≥8-82.1%) compared to the other similar reports.…”

“…PSA distribution among the various other studies of HRPC treatment by RP was not uniform ( Table 5). Mean PSA around 10ng/ml was found in a few studies [7,10,14,15,16,17] while a value between 15-25ng/ml was observed in others, including in our study [5,11,18,19]. Similarly the distribution of biopsy GS was variable.…”

“…[11,15]. Whereas, Furukawa J et al stated one reason for negative prognostic outcome in his series to non-utilization of any adjuvant treatment [5]. Our patient's BCRFS and CSS after 5 years were 68.3% and 89.2% respectively.…”

“…However, it is not clear whether this approach translates into absolute benefit over the radical prostatectomy (RP). Further, there has been a considerable interest in the selection of RP as an initial therapy in selected high risk patients [5,6]. RP has shown excellent long-term outcomes in the HRPC patients and these patients also have the most to gain from the treatment delivered with a curative intent [7].…”