Radical prostatectomy for clinical stage T3a disease

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Clinical stage T3a prostate cancer is high-risk, often treated with radiation and hormonal therapy.
• Long-term outcomes of radical prostatectomy for this group were evaluated.

Purpose of the Study:

• To assess the long-term efficacy of radical prostatectomy in men with clinical stage T3a prostate cancer.
• To identify predictors of outcomes in this patient cohort.

Main Methods:

• Retrospective analysis of 62 men with clinical stage T3a disease treated with radical prostatectomy.
• Evaluation of PSA-free survival, metastasis-free survival, and prostate cancer-specific survival in 56 men without neoadjuvant/adjuvant therapy before PSA recurrence.
• Follow-up ranged from 1 to 17 years (median 10.3 years).

Main Results:

• 91% had pathological T3 disease; 15-year PSA-free survival was 49%, metastasis-free survival 73%, and cause-specific survival 84%.
• Lymph node metastasis was the only predictor of prostate cancer death (HR: 9.22, P = .044).
• Prostate-specific antigen doubling time (PSADT) <9 months significantly predicted increased risk of prostate cancer death (P = .004); no patient with PSADT ≥9 months died of prostate cancer.

Conclusions:

• Radical prostatectomy alone provides durable cancer control in approximately 50% of select men with clinical stage T3a disease, with an 84% prostate cancer-specific survival.
• PSADT at the time of PSA recurrence is a valuable tool for risk stratification and predicting prostate cancer mortality.