Pathological findings and oncological control afforded by radical prostatectomy in men with high-risk prostate...

To assess pathological findings and oncological control afforded by radical prostatectomy (RP) in high-risk prostate cancers (PCa) at our institution.

We performed a retrospective review of prostate cancer patients who underwent RP between 1995 and 2006 for a high-risk prostate cancer (i.e., PSA >20 or biopsy Gleason ≥8 or clinical stage ≥T2c). Biochemical recurrence was defined as a single rise in PSA levels over 0.2 ng/ml after surgery. Survival curves were elaborated by the Kaplan-Meier method and Cox proportional hazard regression analysis. For each patient, a prognostic score for recurrence was estimated, and a prediction model was then constructed.

Overall, 138 patients were included and followed for a median time of 53 months. Mean age at diagnosis was 63.4 years (range 39-80) and mean pre-operative PSA was 15.5 ng/ml (range 7.4-31). The median follow-up was 53 months (range 6-166). Overall, 82 patients (59%) had biochemical recurrence. The five-year PSA recurrence-free survival rate was 40%. In univariate analysis, clinically palpable tumours (T2-T3) (P = 0.032), biopsy Gleason score ≥8 (P = 0.031), seminal vesicle invasion (pT3b), positive margins and positive lymph nodes (P < 0.001) were significantly associated with recurrence. In multivariate analysis, the biopsy Gleason score ≥8, seminal vesicle invasion, positive margins and positive lymph nodes predicted recurrence (P < 0.05).

RP affords an acceptable oncological control at first-line treatment of selected patients with high-risk PCa. However, in certain cases, surgery alone might not be sufficient and may be part of a multimodal treatment including either adjuvant radiotherapy or androgen deprivation.