scholarly journals Short Term Outcomes in Indian Patients with High Risk Prostate Cancer after Laparoscopic Radical Prostatectomy- Data from a Single Institute

2020 ◽  
pp. 1-10
Author(s):  
Prashant Patel ◽  
Shrenik J Shah ◽  
Arpan Choudhary
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Laparoscopic Radical Prostatectomy ◽  
Pathological Stage ◽  
Short Term ◽  
Term Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Background Management of high risk prostate cancer (HRPC) is in evolving stage. Effectiveness of the various treatment strategies is being explored. We examined the short term efficacy of laparoscopic radical prostatectomy (LRP) in treatment of patients with HRPC. Methods Retrospective observational study had 140 HRPC patients of Indian origin, based on D’Amico classification system. Baseline workup was completed. Perioperative parameters and pathological findings were recorded. Multivariate analysis was performed to find predictive factors of pathological stage and PSM. 5 year biochemical recurrence free survival (BCRFS), cancer specific survival (CSS) and overall survival (OS) were calculated. Results Mean age and PSA were 67.24±7.37 years and 23.29 ng/ml respectively. Three fourth of patients had a biopsy GS ≥8. 53.6% of patients were of clinical stage (CS) ≤T2; while 46.4% were of stage ≥T3. Conversion to open surgery rate was 15%. Mean operative time was 210 minutes; blood loss 230 ml; hospital stay 3 days; catheterization time 14 days; grade II or more complication rate 22.1%; LN positivity 20.0%; PSM rate 25.7%; upstaging 35.7%; down-staging 14.3%; pT2 31.4%; pT3a 26.4%; pT3b 42.2%. GS and CS were predictive of pathological stage and PSM respectively. 89.3% of cases were continent postoperatively. 5 year BCRFS, CSS and OS were 68.3%, 89.2% and 78.7% respectively. Conclusions LRP is feasible and effective initial treatment for HRPC. Perioperative morbidity is acceptable. Accurate staging helps in better planning of the adjuvant therapy. Good short term survival can be achieved with multimodal therapy.

LONG-TERM SURVIVAL AFTER RADICAL PROSTATECTOMY FOR PATIENTS WITH HIGH RISK PROSTATE CANCER IN THE PSA ERA

2008 ◽  
Vol 179 (4S) ◽  
pp. 552-553 ◽  
Author(s):  
Stephen A Boorjian ◽  
R Jeffrey Karnes ◽  
Laureano J Rangel ◽  
Eric J Bergstralh ◽  
Michael L Blute
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Term Survival ◽  
Long Term Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Impact of different definitions of high-risk prostate cancer on survival after radical prostatectomy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 113-113
Author(s):  
Kenneth Gerard Nepple ◽  
Gurdarshan S Sandhu ◽  
Dorina Kallogjeri ◽  
Seth A. Strope ◽  
Robert L. Grubb ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cancer Survival ◽  
Clinical Stage ◽  
High Risk Patients ◽  
High Risk Prostate Cancer ◽  
Increased Risk ◽  
Risk Prostate Cancer ◽  
Risk Patients

113 Background: Multiple definitions of high risk prostate cancer exist. Studies have primarily correlated these definitions with biochemical recurrence and not with survival. We applied six previously described high risk definitions to men treated with radical prostatectomy and evaluated their ability to predict survival outcomes in a multi-institutional cohort. Methods: The study population included 6477 men treated with radical prostatectomy between 1995 and 2005 and followed for a median of 67 months. The six high risk definitions were 1) preoperative PSA≥20ng/ml, 2) biopsy Gleason score 8-10, 3) clinical stage≥T2c, 4) clinical stage T3, 5) D’Amico definition, or 6) National Comprehensive Cancer Network definition. Survival was evaluated with the Kaplan-Meier method to generate unadjusted prostate cancer survival estimates. To control for the competing risks of age and comorbidity, multivariable Cox proportional hazard regression models were used to estimate the hazard ratio for prostate cancer specific mortality (PCSM) and overall mortality (OM) in high risk patients compared to low/intermediate risk. Results: High risk patients comprised between 0.7% (cT3) and 8.2% (D’Amico) of the study population. The 10-year Kaplan Meier prostate cancer survival estimates varied from 89.7% for PSA≥20 to 69.7% for cT3. On multivariable analysis controlling for age and comorbidity, high risk prostate cancer (of all definitions) had an increased risk of PCSM compared to low/intermediate risk with a hazard ratio (HR) ranging from 4.38 for PSA≥20 to 19.97 for cT3 (all p<0.0001). For OM, again controlling for age and comorbidity, high risk patients of all definitions except preoperative PSA≥20 (HR=0.98, p=0.99) were associated with increased risk of OM (HR range: 1.72 for D’Amico, 1.73 for stage≥T2c, 1.88 for NCCN, 2.63 for Gleason 8-10, 3.31 for cT3; all p<0.01). Conclusions: In a contemporary cohort of men with high risk prostate cancer treated with radical prostatectomy, the majority of men experienced long term prostate cancer survival. However, heterogeneity in survival outcomes existed based on the definition of high risk used. Clinical stage T3 and high Gleason score were most strongly associated with PCSM and OM.

Long-term oncologic outcomes of neoadjuvant chemohormonal therapy followed by radical prostatectomy for patients with clinically localized, high-risk prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 153-153
Author(s):  
Jonathan L Silberstein ◽  
Stephen A Poon ◽  
Daniel Sjoberg ◽  
Andrew J. Vickers ◽  
Aaron Bernie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Oncologic Outcomes ◽  
Chemohormonal Therapy ◽  
High Risk Prostate Cancer ◽  
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.

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