Long-term evaluation of radical prostatectomy as treatment for clinical stage C (T3) prostate cancer

We reviewed the results of radical prostatectomy in 232 patients with clinical Stage C prostate cancer for comparison with published results of irradiation for clinical Stage C patients. Twenty-two percent were Stage B pathologically (i.e., overstaged clinically); 36 percent were pathologic Stage C and 42 percent were Stage D1. Fifty-four percent had had adjuvant treatment immediately postoperatively. Mean follow-up was 4.9 years, with 86 and 32 patients under observation at five and ten years, respectively. Overall, cause-specific, disease-free, and local recurrence-free survival rates were 84 percent, 89 percent, 69 percent, and 90 percent, respectively, at five years, and 72 percent, 82 percent, 56 percent, and 82 percent, respectively, at ten years. Although adjuvant hormonal treatment affected progression significantly (P = 0.0069), it did not affect survival significantly. When the analysis of survival to a female prostate-specific antigen (PSA) level was combined with clinical disease-free survival to provide a more accurate measure of disease progression, 90 percent, 51 percent, and 38 percent of patients with clinical Stage C prostate cancer were free of disease at one, five, and ten years, respectively. The clinical data suggest that radical surgery often combined with immediate adjuvant therapy may provide better disease control (including PSA values) than primary radiotherapy.