Outcomes of radical prostatectomy in treatment of locally advanced prostate cancer: clinical observations

Abstract

Background. Radical prostatectomy in treatment of locally advanced prostate cancer is currently recommended as one of the stages of multimodal therapy. Despite this, the expediency of surgical intervention remains a subject of discussion: based on the results of their own research, supporters of surgical tactics for treatment of locally advanced prostate cancer point to the effectiveness and relative safety of radical prostatectomy, opponents point to the high probability of a positive surgical edge associated with the operation, local tumor recurrence, lymphogenic metastasis, and formation of distant metastases.Aim. To evaluate the outcomes of laparoscopic radical prostatectomy performed in combination with expanded pelvic lymphadenectomy in treatment of prostate adenocarcinoma T3a–3bN0M0.Materials and methods. The perioperative, functional, and oncological results of surgical treatment of patients with locally advanced prostate cancer (n = 32) aged between 46 years to 71 years were analyzed. The follow-up period averaged 9–36 months (median 13 months).Results. Mean total duration of surgical intervention and mean volume of intraoperative blood loss were 182.69 ± 3.99 minutes and 253.06 ± 9.80 ml, respectively. Overestimation of the clinical stage of the disease, according to histological examination of the surgical material, was observed in 6.3 % of patients. After the intervention, the function of urinary retention was preserved and did not require correction in 65.6 % of men. In all patients 6 months after the operation, the urinary volume, maximum and mean urine flow rates were normalized, and there was a trend toward a decrease in the post-void residual volume. During the entire follow-up period, there were no signs of biochemical relapse in 78.1 % of patients. None of the participants dropped out of the study due to death.Conclusion. Over the last 20 years in specialized medical periodicals, author teams from various countries have shown the immediate and remote (follow-up period from 3 to 20 years) outcomes of radical surgical treatment of locally advanced prostate cancer in at least 80,000 patients in total, while the criterion for exclusion from research was adjuvant therapy. The authors’ conclusions indicate the effectiveness and relative safety of surgical treatment of locally advanced prostate cancer, as well as the importance of extended pelvic lymphadenectomy, which allows to optimize the tactics of adjuvant therapy if necessary. The results of our own observations are completely comparable with the literature data. Currently, scientific research is continuing with the aim of improving the outcomes of surgical treatment of locally advanced prostate cancer, in particular clarifying the role of individual prognostic factors, improving prediction techniques and choosing a rational scheme of treatment measures.