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. 2016 Nov-Dec;42(6):1091-1098.
doi: 10.1590/S1677-5538.IBJU.2016.0290.

Oncological outcomes following radical prostatectomy for patients with pT4 prostate cancer

Dharam Kaushik  1   2 , Stephen A Boorjian  1 , R Houston Thompson  1 , Manuel S Eisenberg  1 , Rachel E Carlson  3 , Eric J Bergstralh  3 , Igor Frank  1 , Matthew T Gettman  1 , Matthew K Tollefson  1 , R Jeffrey Karnes  1
Affiliations

Oncological outcomes following radical prostatectomy for patients with pT4 prostate cancer

Dharam Kaushik et al. Int Braz J Urol. 2016 Nov-Dec.

Abstract

Objectives: Radical prostatectomy (RP) for locally advanced prostate cancer may reduce the risk of metastasis and cancer-specific death. Herein, we evaluated the outcomes for patients with pT4 disease treated with RP.

Materials and methods: Among 19,800 men treated with RP at Mayo Clinic from 1987 to 2010, 87 were found to have pT4 tumors. Biochemical recurrence (BCR)-free survival, systemic progression (SP) free survival and overall survival (OS) were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to assess the association of clinic-pathological features with outcome.

Results: Median follow-up was 9.8 years (IQR 3.6, 13.4). Of the 87 patients, 50 (57.5%) were diagnosed with BCR, 30 (34.5%) developed SP, and 38 (43.7%) died, with 11 (12.6%) dying of prostate cancer. Adjuvant androgen deprivation therapy was administered to 77 men, while 32 received adjuvant external beam radiation therapy. Tenyear BCR-free survival, SP-free survival, and OS was 37%, 64%, and 70% respectively. On multivariate analysis, the presence of positive lymph nodes was marginally significantly associated with patients' risk of BCR (HR: 1.94; p=0.05), while both positive lymph nodes (HR 2.96; p=0.02) and high pathologic Gleason score (HR 1.95; p=0.03) were associated with SP.

Conclusions: Patients with pT4 disease may experience long-term survival following RP, and as such, when technically feasible, surgical resection should be considered in the multimodal treatment approach to these men.

Keywords: Neoplasm Metastasis; Prostatectomy; Prostatic Neoplasms.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1. Kaplan-Meier plot showing 10-year Overall Survival, Systemic progression and biochemical recurrence.
Figure 2
Figure 2. Kaplan-Meier plot showing Systemic-progression stratified by Gleason-score.
Figure 3
Figure 3. Kaplan-Meier plot showing Systemic-progression stratified by nodal status.
See this image and copyright information in PMC

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