Whether radical prostatectomy is viable treatment option in pT3a prostate cancer?

Abstract

Introduction & Objectives: Our aim was to assess the outcome after radical prostatectomy in patients with pT3a prostate cancer also as impact of risk factors and additional treatment on overall mortality, cancer specific mortality, biochemical and clinical progression free survival. Materials & Methods: In a retrospective case control study between 2002 and 2007, in 131 patients were detected T3a stage prostate cancer with N0 or Nx after radical prostatectomy. Were analyzed the impact of risk factors (PSA, Gleason score (GS), surgical margins) and administrated additional (hormone or radiation) treatment for biochemical progression (BP), disease progression (DP), overall also as cancer specific (CS) survival after surgery. Kaplan-Meier analysis with log-rank test and Cox regression analysis were used. Results: Median PSA was 7.95 ng/ml (≤10 ng/ml in 65.8%, 10 to 20 ng/ml in 26.4% and >20 ng/ml in 7.8%). Post operative GS 6 was in 19.8%, GS 7 – in 71.8%, and >7 – 8.4%. Positive margins were detected in 54.8%. Median followup for survival was 56 mo. There were 6 deaths (4.5%) including 1 prostate CS death (0.8%). Median follow-up for BP and DP was 42 mo. During study period DP developed in 2.3% (1 local and 2 distant metastases) and BP in 29.0%. Additional treatment was administrated in 19.1% (adjuvant in 3.1% and salvage in 16.0%). At the last follow-up visit the PSA relapse was detected in 22% and there were no differences between administrated adjuvant or salvage therapy (log-rank test p=0.542) for biochemical recurrence treatment. The multivariable Cox regression models showed no associations between risk factors or additional treatment and overall, CS and DP free survival but increasing PSA (HR 2.316 (95% CI: 1.351- 3.969), p=0.002) and Gleason score (HR 2.545 (95% CI: 1.565-4.136), p<0.0001) were associated with highly increasing risk for BP. According Cox regression analyzes [...].