Results of Radical Prostatectomy in Newly Diagnosed Prostate Cancer

Abstract

Until just a few years ago, locally advanced or high-risk prostate cancer was generally considered incurable. Recently, however, evidence has accumulated that, even for these patients, the oncologic outcome after radical prostatectomy is not uniformly poor. 13 262 evaluable patients with prostate cancer were treated with radical prostatectomy from 1992 to 2012. 4391 had a locally advanced stage, lymphogenous metastases, and/or unfavorable histopathological tumor characteristics. The endpoints of this retrospective, monocentric study were biochemical recurrence-free survival (postoperative PSA value less than 0.2 ng/mL), carcinoma-specific survival, and overall survival. The rates of biochemical recurrence-free survival, carcinoma-specific survival, and overall survival at 10 years were 53%, 98%, and 89% for patients with extraprostatic tumor growth (tumor stage pT3a, 2675 patients); 19%, 87%, and 79% for patients with demonstrated invasion of the seminal vesicle (pT3b, 1373 patients); and 3%, 77%, and 69% for patients with tumor invasion of neighboring organs (pT4, 53 patients). The corresponding figures were 14%, 81%, and 71% for patients with lymph node metastases (682 patients); 32%, 93%, and 85% for those with a preoperative PSA value above 20 ng/mL (728 patients); and 25%, 70%, and 58% for those with a prostatectomy Gleason score of 8 or more points (559 patients). Even patients with locally advanced, nodally metastasized, or localized high-risk prostate cancer do not necessarily have a poor outcome. Although most such patients have a biochemical recurrence after radical prostatectomy, their carcinoma-specific mortality within ten years of radical prostatectomy ranges from 2% to 30% depending on the risk constellation, while their overall survival rate over the same period ranges from 58% to 89%.