Re: 20-Year Survival After Radical Prostatectomy as Initial Treatment for cT3 Prostate Cancer

Abstract

Objective: To present long-term survival outcomes after radical prostatectomy (RP) for patients with cT3 prostate cancer, as the optimal treatment for patients with clinical T3 prostate cancer is debated. Patients and Methods: We identified 843 men who underwent RP for cT3 tumours between 1987 and 1997. Survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to evaluate the association of clinicopathological features with outcome. Results: The median (range) postoperative follow-up was 14.3 (0.1–23.5) years. Down-staging to pT2 disease occurred in 26% (223/843) at surgery. Local recurrence-free, systemic progression-free and cancerspecific survival for men with cT3 prostate cancer after RP was 76%, 72%, and 81%, respectively, at 20 years. On multivariate analysis, increasing RP Gleason score (hazard ratio [HR] 1.8; P 0.01), non-diploid chromatin content (HR 1.8; P 0.01), positive surgical margins (HR 2.1; P 0.007), and seminal vesicle invasion (HR 2.1; P 0.005) were associated with a significant risk of prostate cancer death, while a more recent year of surgery was associated with a decreased risk of cancer-specific mortality (HR 0.88; P 0.01). Conclusions: RP affords accurate pathological staging and may be associated with durable cancer control for cT3 prostate cancer, with 20 years of follow-up presented here. RP as part of a multimodal treatment strategy therefore remains a viable treatment option for patients with cT3 tumours.