Abstract
The role of surgery in clinical stage T3 prostate cancer (cT3 PCa) is still subject to debate. We reviewed the records of 139 consecutive patients who underwent a radical prostatectomy (RP) for cT3 PCa with a mean follow-up of 8 years. All data related to surgical and perioperative complications were collected. Continence and erectile function were assessed at 12 months postoperatively and long-term oncologic outcomes were analyzed. Rectal injury and injury of the obturator nerve occurred both in 0.7% of cases. No serious in-hospital complications were noted and no reintervention was needed. Lymphatic leakage was noted in 2.2% of patients and 1.4% experienced prolonged drainage of urine. In 7.2%, wound-related problems occurred. Anastomotic stricture occurred in 2.9%. These complication rates were not different compared to surgical series of RP in localized PCa. At 12 months, complete continence was 87.8% and erectile function had fully recovered in 6% and 10% of patients who underwent a non-nerve sparing or unilateral nerve-sparing procedure, respectively. 10-year estimated biochemical PFS, clinical PFS, CSS and OS were 51.8%, 85.6%, 94.6% and 85.9%, respectively. In cT3 PCa, RP is technically feasible with morbidity comparable to RP in clinically localized PCa. Long-term oncologic control was excellent.
Highlights
Advanced prostate cancer (PCa) is defined as cancer that has extended clinically beyond the prostatic capsule with invasion of the pericapsular tissue, the sphincter muscle, bladder neck, or seminal vesicles, but without lymph node involvement or distant metastases [1]
We reviewed the records of 139 consecutive patients who underwent a radical prostatectomy (RP) for clinical stage T3 prostate cancer (cT3 PCa) with a mean follow-up of 8 years
Our experience with 139 patients confirms the surgical feasibility of RP for cT3 PCa, showing complication rates comparable with RP in organ-confined PCa and showing a very low incidence of positive surgical margins and associated failure of surgery
Summary
Advanced prostate cancer (PCa) is defined as cancer that has extended clinically beyond the prostatic capsule with invasion of the pericapsular tissue, the sphincter muscle, bladder neck, or seminal vesicles, but without lymph node involvement or distant metastases [1]. In a recent population-based Swedish study, 18.6% of prostate cancers presented as locally advanced, nonmetastatic PCa [3] In another recent paper, based upon data from the SEER (Surveillance, Epidemiology, and End Results) database, between 11.6% and 15.3% of the patients presented with cT3 N0 M0 PCa, while 8% to 10.9% presented with T4 and/or N1 and/or M1 PCa [4]. These data from Europe and the US provide an estimation of the incidence of cT3-4 PCa, which is thought to be between 15 and 25%
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