CANCER CONTROL WITH RADICAL PROSTATECTOMY ALONE IN 1,000 CONSECUTIVE PATIENTS

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2002CANCER CONTROL WITH RADICAL PROSTATECTOMY ALONE IN 1,000 CONSECUTIVE PATIENTS GERALD W. HULL, FARHANG RABBANI, FARHAT ABBAS, THOMAS M. WHEELER, MICHAEL W. KATTAN, and PETER T. SCARDINO GERALD W. HULLGERALD W. HULL More articles by this author , FARHANG RABBANIFARHANG RABBANI More articles by this author , FARHAT ABBASFARHAT ABBAS More articles by this author , THOMAS M. WHEELERTHOMAS M. WHEELER Financial interest and/or other relationship with Astra Zeneca Pharmaceuticals. More articles by this author , MICHAEL W. KATTANMICHAEL W. KATTAN More articles by this author , and PETER T. SCARDINOPETER T. SCARDINO More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)69079-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We analyzed the long-term progression-free probability after radical retropubic prostatectomy in a consecutive series of patients with localized prostate cancer. Materials and Methods: From 1983 to 1998, 1,000 patients (median age 62.9 years, range 37.7 to 81.4) with clinical stage T1 to T2 prostate cancer were treated with radical retropubic prostatectomy and pelvic lymphadenectomy, without other cancer related therapy before recurrence. Mean followup was 53.2 months (median 46.9, range 1 to 170). Results: Ten years after radical retropubic prostatectomy the mean probability ± 2 standard errors that patients remained free of progression and of any further treatment was 75.0% ± 3.7% and of metastasis 84.2% ± 4.4%. Mean actuarial cancer specific survival rate ± 2 standard error was 97.6% ± 1.7%. In a multivariate analysis pretreatment prostate specific antigen level (p <0.0001), biopsy Gleason sum (p <0.0001) and clinical stage (p=0.0071) were independent prognostic factors for progression. After prostatectomy independent risk factors were Gleason sum in the prostatectomy specimen (p=0.0008), extracapsular extension (p=0.0019), seminal vesical involvement (p <0.0001), lymph node metastasis (p <0.0001) and surgical margin status (p <0.0001). Margins were positive in 12.8% of cases. At 10 years postoperatively radical retropubic prostatectomy was effective for cancer confined to the prostate (92.2% progression-free probability) and also not confined (52.8%), including 71.4% progression-free probability for patients with only extracapsular extension and 37.4% with seminal vesicle invasion without lymph node metastasis. Conclusions: Radical retropubic prostatectomy provided long-term cancer control in 75% of patients with clinically localized prostate cancer and was effective in the majority of those with high risk cancer, including T2c or biopsy Gleason sum 8 to 10, or PSA greater than 20 ng./ml. Further research should address identifying patients who can safely avoid aggressive therapy. References 1 : Results of conservative management of clinically localized prostate cancer. N Engl J Med1994; 330: 242. Crossref, Medline, Google Scholar 2 : Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA1998; 280: 975. Crossref, Medline, Google Scholar 3 : The Prostate Cancer Intervention Versus Observation Trial (PIVOT). Oncology (Huntingt)1997; 11: 1133. Medline, Google Scholar 4 : A decision analysis for treatment of clinically localized prostate cancer. J Gen Intern Med1997; 12: 299. 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Crossref, Medline, Google Scholar From the Department of Urology, Medical University of South Carolina, Charleston, South Carolina, Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, Department of Surgery-Urology, Aga Khan University, Karachi, Pakistan, and Department of Pathology, Baylor College of Medicine, Houston, Texas© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Stankovic M, Wolff L, Wieder T, Mendes J, Schumacher B, Barro-Bejarano M and Weber C (2023) La prostatectomía radical retropúbica abierta es todavía una técnica quirúrgica bien establecida para el tratamiento del cáncer de próstataActas Urológicas Españolas, 10.1016/j.acuro.2022.09.004, Online publication date: 1-Feb-2023. 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