What are the outcomes of radical prostatectomy for high-risk prostate cancer?

Stacy Loeb, Edward M. Schaeffer, Bruce J. Trock, Jonathan I. Epstein, Elizabeth B. Humphreys, Patrick C. Walsh

Research output: Contribution to journalArticle

97 Scopus citations

Abstract

Objectives: To examine the long-term survival following radical prostatectomy in the population with high-risk prostate cancer. Despite considerable stage migration associated with widespread prostate-specific antigen screening, as many as one-third of incident prostate cancers have high-risk features. These patients are often treated with combined radiation and androgen deprivation therapy, and less is known about the long-term survival in this population after radical prostatectomy (RP). Methods: Between 1992 and 2008, 175 men underwent RP by a single surgeon with D'Amico high-risk prostate cancer (clinical stage <T2c, biopsy Gleason score 8-10, or prostate-specific antigen >20 ng/mL). In this population, we examined the rates and predictors of biochemical progression, metastatic disease, and cancer-specific mortality. Results: Among 175 high-risk patients, 63 (36%) had organ-confined disease in the RP specimen. At 10 years, biochemical recurrence-free survival was 68%, metastasis-free survival was 84%, and prostate cancer-specific survival was 92%. The 10-year rate of freedom from any hormonal therapy was 71%. Of the high-risk criteria, a biopsy Gleason score of 8-10 (vs ≤7) was the strongest independent predictor of biochemical recurrence, metastases, and prostate cancer death. Conclusions: National data suggest that RP may be underutilized for the management of high-risk clinically localized prostate cancer. Our data suggest that surgical treatment can result in long-term progression-free survival in a subset of carefully selected high-risk men. Further prospective studies are warranted to directly compare the outcomes of RP vs combined radiation and hormonal therapy in high-risk patients.

Original languageEnglish (US)
Pages (from-to)710-714
Number of pages5
JournalUrology
Volume76
Issue number3
DOIs
StatePublished - Sep 2010

ASJC Scopus subject areas

  • Urology

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    Loeb, S., Schaeffer, E. M., Trock, B. J., Epstein, J. I., Humphreys, E. B., & Walsh, P. C. (2010). What are the outcomes of radical prostatectomy for high-risk prostate cancer? Urology, 76(3), 710-714. https://doi.org/10.1016/j.urology.2009.09.014