Efficacy of radical prostatectomy for the treatment of high-risk prostate carcinomas

DOI: 10.22591/magyurol.2018.2.berczics.55

Authors:
Berczi Csaba dr., Kiss Zoltán dr., Flaskó Tibor dr.
Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Klinika, Debrecen (igazgató: Dr. Flaskó Tibor)

Summary

Objective: At present there is no consensus regarding the optimal treatment of patients with high-risk prostate cancer. The authors measured the efficacy of radical prostatectomies for high-risk tumors at their institute.
Material and method: From January 1996 to January 2016, 2022 patients underwent radical prostatectomy and they were involved into the study. The mean age of the patients was 63.5±6.4 years. In their cases the mean preoperative PSA level was 12.3 ng/ml. High-risk prostate cancer was present in 356 cases (17.6%). The mean age of these patients was 63.7±7.2 years and their mean preoperative PSA level was 29.4 ng/ml.
Preoperative CT examination was performed in 174 cases and it showed locally advanced tumor in 15 patients with high-risk tumors. MRI and MRI with endorectal coil were carried out in 123 and 36 occasions and they detected locally advanced tumor in 29 and in 16 patients.
Observation, adjuvant or salvage irradiation or/and hormonal therapy were administered in the follow-up period regarding to the actual guideline and the patient’s condition.
Results: The histology showed locally advanced tumor (pT3) in 169 of the 356 patients (47.4%). Margin positivity occurred in 88 cases (28.7%). Biochemical progression was detected in 42 (11.7%) cases, while local recurrency and distant metastases were diagnosed in 12 (3.3%) and in 7 (1.9%) patients with high-risk tumor during the 5 year follow-up period. Irradiation and hormonal treatment were performed in 22.7% and in 30.8% of the patients after the radical prostatectomy.
Conclusion: The presence of locally advanced tumor and margin positive status are common in patients with high-risk prostate cancer. However, the radical prostatectomy as a part of multimodal treatment provides reasonable oncological outcome.

click here to read the full article