What is the best postoperative treatment for patients with pT3bN0M0 adenocarcinoma of the prostate?

Abstract

The purpose of this paper to identify the optimal therapy after radical prostatectomy (RP) for patients with adenocarcinoma of the prostate invading the seminal vesicles (pT3bN0M0 or SVI). A PubMed search using the keywords 'prostate', 'seminal vesicle', 'prostatectomy', 'radiotherapy', 'androgen blockade' was performed to identify literature regarding rates of disease failure in patients with SVI who are observed or treated with androgen blockade (AB), radiotherapy (RT) or RT þAB after RP. The outcome of 68 patients treated at Duke University with post-operative AB, RT or RT þAB for pT3bN0M0 is also presented. More than 70% of patients with SVI develop disease recurrence after surgery. For many, recurrence occurs within 2 y after RP. These patients have poor control rates with postoperative RT alone. While experience with AB and RT þAB is limited, control rates are generally superior to RT alone. At Duke University, after a median followup of nearly 4 y, patients treated with RT þAB or AB alone for pT3bN0M0 achieved better 5-y progression-free survival (PFS) compared with those who received RT alone (78 and 68 vs 30%, P ¼ 0.03 and 0.046, respectively). There was no PFS difference between those who received AB alone or RT þAB (68 vs 78%, P ¼ 0.5). Seminal vesicle invasion confers a poor prognosis after RP. SVI is a consistent predictor of poor outcome after RT. The limited data available examining AB and RT þAB in pT3bN0M0 disease, including data from Duke University, are encouraging. Nonetheless, postoperative AB, RT and RT þAB for pT3bN0M0 disease require prospective evaluation, as RP alone is rarely curative.

Patoloji̇k T3 Evre Prostat Kanseri̇nde Cerrahi̇ Sinir Pozi̇ti̇fli̇ği̇ Ve Radyoterapi̇

“…pT3 evresinin de kendi içinde rekürrens açısından farklılıklar görülmektedir. pT3a'nın, cerrahi sınır pozitifliğinde lokal kontrolü zorlaşırken T3b'de cerrahi sınır pozitifliğinden bağımsız olarak uzak hastalık varlığında rekürrens riskinde artış olabilmektedir (11). Yani cerrahi sınır pozitifliği her zaman rekürrensle sonuçlanmayabilir (12,13,14).…”

Estilo de vida y agresividad del cáncer de próstata.

“…El objetivo de nuestro estudio fue establecer una asociación entre diversas variables demográficas y epidemiológicas, como el estado civil, el nivel de educación, los factores de riesgo cardiovascular, el ejercicio, la ingesta de alcohol y el tabaquismo, con características de agresividad del CaP, como extensión extraprostática (EEP), márgenes positivos (MP) e invasión de vesículas seminales (IVS), entre otros factores que se relacionan con recidiva bioquímica (Kasibhatla et al, 2005, Stephenson et al, 2014, e incluso, en el caso de los MP, hasta un 50% de los pacientes puede presentar recidiva bioquímica (Sooriakumaran et al, 2016).…”