Primary surgical therapy for clinical stage T3 adenocarcinoma of the prostate

Radical prostatectomy has not been a widely accepted treatment option in patients with clinical stage T3 prostate cancer due to the potential for incomplete excision of tumor and the high incidence of lymph node metastases. In addition, the morbidity of surgical therapy in these patients has been questioned. As a result, alternative treatment modalities, including androgen ablative therapy and radiotherapy, are often used in patients with locally advanced disease. However, in terms of local disease control and long-term disease-free survival rates, most alternative treatments have serious limitations in clinical stage T3 tumors. We recently reported our extended experience with radical prostatectomy and adjuvant therapy in a large group of patients with clinical stage T3 disease and this article updates that experience. Although 31% of patients in our series had node-positive disease, 25% had pathologically organ-confined tumors likely to be cured by surgical therapy alone. Cancer-specific survival rates at 5, 10, and 15 years were 93%, 84%, and 74%, respectively, and operative morbidity paralleled that of patients with clinically localized disease. Our experience suggests that excellent long-term survival with low treatment-related morbidity can be achieved with radical prostatectomy and adjuvant therapy in patients with clinical stage T3 prostate cancer.