The Impact of Pathologic Staging on the Long-Term Oncologic Outcomes of Patients With Clinically High-Risk Prostate Cancer

153 Background: To determine long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemo-hormonal therapy for clinically localized, high-risk prostate cancer. Methods: In this phase II multicenter trial of patients with high-risk prostate cancer (prostate-specific antigen greater than 20ng/ml, Gleason greater than or equal to 8, or clinical stage greater than or equal to T3), androgen deprivation therapy (goserelin acetate depot) and paclitaxel, carboplatin and estramustine were administered prior to RP. We report the long-term oncologic outcomes of these patients and compared them to a contemporary cohort who met oncologic inclusion criteria but received RP only. Results: Thirty four patients were enrolled in this study and followed for a median of 13.1 years. Within 10 years most patients experienced biochemical recurrence (BCR-free probability= 22%; 95% CI 10%, 37%). However the probability of disease-specific survival at 10 years was 84% (95% CI 66%, 93%) and overall survival was 78% (95% CI 60%, 89%). The chemohormonal therapy group had higher-risk features than the comparison group (N=123 patients) with an almost doubled risk of calculated preoperative 5-year BCR (69% vs 36%, p<0.0001). After adjusting for these imbalances the CHT group had trends toward improvement in BCR (0.76, 95% CI 0.43, 1.34; p=0.3) and metastasis free survival (0.55, 95% CI 0.24, 1.29; p=.2) although these were not significant. Conclusions: Neoadjuvant chemohormonal therapy followed by RP was associated with lower observed rates of BCR and metastasis compared to a prostatectomy only group; however these results were not significant. Because this treatment strategy has known harms and unproven benefit, this strategy should only be instituted in the setting of a clinical trial.

Download Full-text

Long-term oncologic outcomes of radical prostatectomy compared with brachytherapy-based approaches for intermediate- and high-risk prostate cancer

Brachytherapy ◽

10.1016/j.brachy.2014.08.047 ◽

2015 ◽

Vol 14 (2) ◽

pp. 142-147 ◽

Cited By ~ 8

Author(s):

Juanita Crook

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Oncologic Outcomes ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

Download Full-text

Long-term oncologic outcomes of radiotherapy combined with maximal androgen blockade for localized, high-risk prostate cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-018-1395-5 ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 1

Author(s):

Yong Luo ◽

Mingchuan Li ◽

Hengzhi Qi ◽

Jiahui Zhao ◽

Yili Han ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Oncologic Outcomes ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer ◽

Maximal Androgen Blockade ◽

Androgen Blockade

Download Full-text

Radical Prostatectomy in High-Risk Prostate Cancer Patients: Results of a Single- Institution Study

Songklanagarind Medical Journal ◽

10.31584/smj.2018.36.1.766 ◽

2018 ◽

Vol 36 (1) ◽

pp. 45

Author(s):

Virote Chalieopanyarwong ◽

Worapat Attawettayanon ◽

Watid Kanchanawanichkul ◽

Choosak Pripatnanont

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Cancer Control ◽

Clinical Recurrence ◽

High Risk Prostate Cancer ◽

Kaplan Meier ◽

Pathologic Staging ◽

Risk Prostate Cancer

Objective: To evaluate long-term outcomes of radical prostatectomy and bilateral pelvic lymph node dissection (RP) for high-risk prostate cancer (PC).Material and Method: A retrospective review of high-risk PC patients who received RP, identified from medical records. We collected data from Songklanagarind Hospital, Prince of Songkla University from 2007 to 2015. The Kaplan-Meier method and Cox proportional regression models were used to analyze clinical recurrence (CR) and biochemical recurrence (BCR).Results: In 79 patients, the median follow-up was 27.2 months. The 3-year and 5-year biochemical free survival in men with high-risk PC were 67.7% and 62.9% respectively. Multivariate analysis shows that pathologic stage 3a (hazard ratio=4.87; 95% confidence interval=1.01-23.38) was independently associated with cancer control.Conclusion: Data support the belief that RP has a place in the treatment of high-risk PC. RP was a long-term cancer control in patients with high-risk PC. Only pathologic staging was independently associated with cancer control outcome.

Download Full-text

Robot-Assisted Radical Prostatectomy in Patients With Clinically High-Risk Prostate Cancer: Surgical Feasibility and Long-Term Functional and Oncologic Outcomes

10.21203/rs.3.rs-425802/v1 ◽

2021 ◽

Author(s):

Yong Seong Lee ◽

Tae Young Shin

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Survival Rates ◽

Oncologic Outcomes ◽

Robot Assisted ◽

Free Survival ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

Abstract Background Robot-assisted radical prostatectomy (RARP) is an acceptable procedure for localized prostate cancer. However, RARP has not been offered to patients with high-risk prostate cancer. We report long-term functional and oncologic outcomes of patients who underwent RARP for clinically high-risk prostate cancer and to assess the role of RARP in patients with high-risk prostate cancer. Methods This study included 90 patients with high-risk prostate cancer according to the D'Amico criteria who underwent RARP between January 2014 and December 2019. High risk was based on the presence of a clinical stage of ≥ T2c, a pretreatment prostate-specific antigen level > 20 ng/mL, or a biopsy Gleason score ≥ 8. Functional outcomes including postoperative continence and potency were assessed at 1, 3, 6, and 12 months after RARP. Oncologic outcomes comprised positive surgical margins (PSMs), biochemical recurrence (BCR), BCR-free survival, and clinical recurrence (CR)-free survival rates at 1 and 3 years. Results The median operative time was 185 (interquartile range [IQR], 140–250) minutes. Based on postoperative pathology, the rates of PSMs in the entire cohort and in those with stage pT2 disease were 27.8% and 8.9%, respectively. The continence and potency rates at 12 months were 87.8% and 56.7%, respectively. The BCR rate was 23.3%, and the median time to BCR was 10.5 (IQR, 3.5–26.9) months. The 1- and 3-year BCR-free survival rates were 91.5% and 85.5%, respectively, and the 1- and 3-year CR-free survival rates were 97.5% and 90.8%, respectively. Conclusions Most patients with clinically high-risk prostate cancer treated with RARP remained BCR-free and CR-free during the long-term follow-up. The optimal functional and oncologic outcomes indicating RARP as a safe and feasible approach in the present study should be confirmed in future studies.

Download Full-text