Vol. 42 (6): 1091-1098, November – December, 2016
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
1 Department of Urology, Mayo Clinic, Rochester, Minnesota, USA; 2 Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA; 3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
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: Prostatic Neoplasms; Prostatectomy; Neoplasm Metastasis