Radical prostatectomy for clinical stage T3a disease

Authors

  • Stephen J. Freedland MD,

    Corresponding author
    1. Departments of Urology and Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
    2. Department of Surgery, Veterans Administration Medical Center, Durham, North Carolina
    3. Division of Urologic Surgery and Duke Prostate Center, Departments of Surgery and Pathology, Duke University School of Medicine, Durham, North Carolina
    • DUMC Box 3850, Duke University Medical Center, Durham, NC 27710
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    • Fax: (919) 668-7093

  • Alan W. Partin MD, PhD,

    1. Departments of Urology and Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
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  • Elizabeth B. Humphreys BS,

    1. Departments of Urology and Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
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  • Leslie A. Mangold MS,

    1. Departments of Urology and Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
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  • Patrick C. Walsh MD

    1. Departments of Urology and Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland
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  • The views and opinions of and endorsements by the author(s) do not reflect those of the US Army or the Department of Defense.

Abstract

BACKGROUND

Men with clinical stage T3a disease are at high risk and are often encouraged to undergo radiation therapy with concomitant hormonal therapy. The long-term outcomes among men treated with radical prostatectomy for clinical stage T3a disease were examined.

METHODS

Among 3397 men treated by radical prostatectomy by 1 surgeon between 1987 and 2003, 62 (1.8%) men were identified who had clinical stage T3a disease. Among the 56 men not treated with neoadjuvant or adjuvant therapies before prostate-specific antigen (PSA) recurrence, the long-term outcomes of PSA-free survival, metastasis-free survival, and prostate cancer specific survival were examined. Median and mean follow-up after surgery were 10.3 and 13 years, respectively (range, 1–17).

RESULTS

Ninety-one percent of men in this group had pathological T3 disease. PSA-free survival at 15 years after surgery was 49%. Metastasis-free survival and cause-specific survival at 15 years after surgery were 73% and 84%, respectively. Among men with a PSA recurrence, 46% received secondary therapy before metastasis. The only preoperative or pathological feature that predicted risk of prostate cancer death was lymph node metastasis (hazard ratio [HR]: 9.22, 95% confidence interval [CI]: 1.06–80.02, P = .044). Among the 28 men with a PSA recurrence, PSA doubling time (PSADT) data were available for 23, of which 11 (48%) has a PSADT ≥9 months. No patient with a PSADT ≥9 months died of prostate cancer. A PSADT <9 months was significantly associated with increased risk of prostate cancer death (log-rank, P = .004).

CONCLUSIONS

In a select cohort of men with clinical stage T3a disease, radical prostatectomy alone provides long-term cancer control in about half of the men and results in a prostate cancer-specific survival of 84%. Among men with a PSA recurrence, PSADT at the time of recurrence is a useful determinant of risk of prostate cancer death. Cancer 2007. © 2007 American Cancer Society.

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