[Radical prostatectomy as monotherapy for locally advanced prostate cancer (T3a): 12 years follow-up]

To evaluate the oncological and functional results of radical prostatectomy as monotherapy for stage T3a prostate cancer.

We include our initial and consecutive series of 83 patients with prostate cancer (studied by digital rectal examination and transrectal ultrasound) who had not received neoadjuvant treatment undergoing radical prostatectomy from July 1988 to December 2003. No patient received adjuvant treatment, and deferred intermittent androgen blockade was used when patients with biochemical progression exceeded a PSA of 4ng/ml. Up

After a mean follow-up of 68.7 (1-139) months: overall and specific survival 97.6% and 100% respectively; biochemical progression 36.1% (22 pT2 (0%), 41 p T3a (36.6%), 13 pT3b (61.5%) and 7pT4a (100%)). Positive margins 61.4% (41.2% unifocal with a progression rate of 23.8%). 96.4% achieved continence and 39.6% recovered potency. Among 30 patients with biochemical progression, 19 required treatment with deferred intermittent androgen blockade (one cycle in 10 patients, two cycles in six, and three cycles in the remaining three).

Our results support the indication of radical prostatectomy as single therapy without neoadjuvant treatment as a curative indication for locally advanced prostate cancer (T3a) whenever complete excision is expected: Gleason 7 T3 tumors without diffuse extension on ultrasound. 26.5% of these T3a patients were overstaged and resulted to be organ-confined (pT2). Ten-year probability of biochemical progression-free survival was 100% for pT2 and 81.9% for the lower risk pT3a (well or moderately-differentiated with negative surgical margins or unifocal). Functional results for T3a were similar to the ones of the clinically-localized (T2) series for both retropubic and perineal approaches. 30 patients had developed biochemical progression at the time of study closure and were free of hormonal treatment during 81.6% of the total follow-up time with our deferred intermittent androgen blockade treatment line, so that we consider we can offer it as the first treatment option for progression providing a maximal quality of life and allowing ulterior second line therapies. Patients who mainly benefited were those on progression who have recovered sexual function: 41.7% of potent patients after radical prostatectomy recovered potency again over the second phase (no treatment) of the deferred intermittent androgen blockade.