Adult urologyIntermediate-Term Potency, Continence, and Survival Outcomes of Radical Prostatectomy for Clinically High-Risk or Locally Advanced Prostate Cancer
Section snippets
Material and Methods
From 1984 to 2003, 3478 men underwent radical prostatectomy by a single surgeon (W.J.C.). Most of these men presented, or were referred, with the goal of undergoing nerve-sparing surgery, if possible. This group included 254 men with high-risk Stage cT2b disease (prostate-specific antigen [PSA] greater than 15 ng/mL or a Gleason score of 8 to 10), and 34 men with Stage cT3 disease, who either desired surgical treatment or were deemed to be reasonable surgical candidates because of otherwise
Results
A total of 254 men (88%) with high-risk Stage cT2b and 34 men (12%) with Stage cT3 disease underwent radical prostatectomy from 1984 to 2003. The mean age was 63 ± 7.1 years (range 38 to 77), and 219 (76%) were potent preoperatively. The racial distribution was 273 white (95%), 9 black (3%), and 6 other ethnicities (2%). The mean PSA level at diagnosis was 19.8 ng/mL (median 17.5, range 0.2 to 98.0), and the median follow-up was 88 months (range 0 to 200).
Table 1, Table 2, Table 3 list the
Comment
The optimal treatment regimen for men with high-risk or locally advanced prostate cancer is controversial. Denberg et al.2 used Surveillance, Epidemiology, and End Results data from 1995 to 2001 to examine treatment use trends among men with Stage cT3 disease. Overall, during this period, the proportion of men with locally advanced disease who received aggressive therapy increased by 11%. However, on further analysis, it was found that this increase was entirely due to a 20% rise in the use of
Conclusions
Most men who are currently treated for high-risk or locally advanced prostate cancer receive a combination of radiotherapy and hormonal therapy. Fewer data are available on the long-term outcomes of surgery in this patient population. In this series, radical prostatectomy was associated with a 10-year PFS, CSS, and OS rate of 35%, 88%, and 74%, respectively, either as monotherapy or as part of multimodality therapy. The complication rate was low, and the preservation of both continence and
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This study was supported in part by the Beckman Coulter, Incorporated, Fullerton, California, and the Urological Research Foundation.