RP Suitable for High-Risk Localized PCa

Radical prostatectomy (RP) for very high-risk locally advanced prostate cancer (PCa), with or without adjuvant or neoadjuvant treatment, can provide “very satisfactory” outcomes, according to researchers.

Guidelines from the European Association of Urology and National Comprehensive Cancer Network accept RP as a treatment option in selected patients with locally advanced (cT3a) prostate cancer. More controversy exists regarding the role of RP in very high-risk PCa—cancer that has invaded the seminal vesicles (cT3b) or has extended into the bladder neck (cT4).

In a study of 51 patients with cT3b-T4 PCa who underwent RP, Steven Joniau, MD, of University Hospitals Leuven, Leuven, Belgium, and colleagues found that 10-year cancer-specific and overall survival rates were 91.9% and 70.7%, respectively. The 10-year rates of biochemical progression-free survival (BPFS) and clinical progression-free survival (CPFS) were 45.8% and 72.5%, respectively. Multivariate analyses showed that only pathologic stage was an independent predictor of BPFS and pathologic Gleason score and preoperative PSA levels were the only independent predictors of CPFS, Dr. Joniau's group reported in the Scandinavian Journal of Urology and Nephrology (2012;46:164-171).

Of the 51 patients, 17 (33%) received neoadjuvant androgen deprivation therapy (ADT) and 27 (52.9%) received adjuvant radiotherapy, adjuvant ADT, or both. Eighteen patients (35.3%) received salvage treatment.

The researchers noted that locally advanced PCa historically had been considered inoperable and has been treated mostly with ADT, radiotherapy, or both.

The study population had a mean age of 64.2 years and a median follow-up of 108 months (range 11-210 months). Patients had a median preoperative PSA level of 16.9 ng/mL. In addition, 32 patients (62.7%) had positive surgical margins and 11 (21.6%) had positive lymph nodes.

The researchers noted that the study's relatively small number of patients was a study limitation, as was the retrospective nature of the investigation.

The study is not the first to show that RP can be an option for high-risk localized PCa. Last year, for example, Dan Lewinshtein, MD, and collaborators at Virginia Mason Medical Center in Seattle published findings in Advances in Urology showing that men with pathologic Gleason 8-10 PCa had a predicted 10-year rate of biochemical recurrence-free, metastasis-free, and cancer-specific survival of 59%, 88%, and 94%, respectively. The authors concluded, “We have demonstrated that cancer control is durable even 10 years after RP in those with pathologic Gleason 8-10 disease.”

The study, which included 91 patients, found that pathologic stage and surgical margin status were not significantly associated with outcomes.

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