Radical prostatectomy in clinically localized high-risk prostate cancer: outcome of 231 consecutive patients

The optimal therapeutic strategy for high-risk localized prostate cancer (PCa) is controversial. Supported by randomized trials, the combination of external beam radiation therapy (EBRT) and endocrine therapy (ET) is advocated by many, while radical prostatectomy (RP) is regarded as primary therapy by others. This study examined the outcome for high-risk localized PCa patients treated with RP.

Of 1300 patients who underwent RP, 231 were identified as high-risk. Patients were followed for biochemical recurrence (BCR) (defined as prostate-specific antigen ≥ 0.2 ng/ml), metastatic disease and survival. Excluding node-positive patients, none of the patients received adjuvant therapy before BCR was confirmed. Univariate and multivariate analysis was performed with Kaplan-Meier and Cox proportional hazard models.

Median follow-up was 4.4 years (range:0.1-14.9). The estimated 10-year biochemical recurrence-free survival was 49%, 10-year metastasis-free survival was 81%, 10-year overall survival was 84% and estimated cause-specific survival after 10 years was 90%. In multivariate analysis extracapsular extension, seminal vesicle invasion and young age were significant predictors of BCR.

The results confirm that a significant proportion of patients with high-risk PCa remain biochemically diseasefree and without a need for ET following RP as the primary and only treatment. A large randomized study of RP as primary therapeutic strategy versus the combination of EBRT and ET in patients with high-risk localized PCa seems warranted.