OBJECTIVES: To examine the long-term survival following radical prostatectomy in the population with high-risk prostate cancer. Despite considerable stage migration associated with widespread prostate-specific antigen screening, as many as one-third of incident prostate cancers have high-risk features. These patients are often treated with combined radiation and androgen deprivation therapy, and less is known about the long-term survival in this population after radical prostatectomy (RP). METHODS: Between 1992 and 2008, 175 men underwent RP by a single surgeon with D'Amico high-risk prostate cancer (clinical stage ≥T2c, biopsy Gleason score 8-10, or prostate-specific antigen >20 ng/mL). In this population, we examined the rates and predictors of biochemical progression, metastatic disease, and cancer-specific mortality. RESULTS: Among 175 high-risk patients, 63 (36%) had organ-confined disease in the RP specimen. At 10 years, biochemical recurrence-free survival was 68%, metastasis-free survival was 84%, and prostate cancer-specific survival was 92%. The 10-year rate of freedom from any hormonal therapy was 71%. Of the high-risk criteria, a biopsy Gleason score of 8-10 (vs ≤7) was the strongest independent predictor of biochemical recurrence, metastases, and prostate cancer death. CONCLUSIONS: National data suggest that RP may be underutilized for the management of high-risk clinically localized prostate cancer. Our data suggest that surgical treatment can result in long-term progression-free survival in a subset of carefully selected high-risk men. Further prospective studies are warranted to directly compare the outcomes of RP vs combined radiation and hormonal therapy in high-risk patients.
OBJECTIVES: To examine the long-term survival following radical prostatectomy in the population with high-risk prostate cancer. Despite considerable stage migration associated with widespread prostate-specific antigen screening, as many as one-third of incident prostate cancers have high-risk features. These patients are often treated with combined radiation and androgen deprivation therapy, and less is known about the long-term survival in this population after radical prostatectomy (RP). METHODS: Between 1992 and 2008, 175 men underwent RP by a single surgeon with D'Amico high-risk prostate cancer (clinical stage ≥T2c, biopsy Gleason score 8-10, or prostate-specific antigen >20 ng/mL). In this population, we examined the rates and predictors of biochemical progression, metastatic disease, and cancer-specific mortality. RESULTS: Among 175 high-risk patients, 63 (36%) had organ-confined disease in the RP specimen. At 10 years, biochemical recurrence-free survival was 68%, metastasis-free survival was 84%, and prostate cancer-specific survival was 92%. The 10-year rate of freedom from any hormonal therapy was 71%. Of the high-risk criteria, a biopsy Gleason score of 8-10 (vs ≤7) was the strongest independent predictor of biochemical recurrence, metastases, and prostate cancer death. CONCLUSIONS: National data suggest that RP may be underutilized for the management of high-risk clinically localized prostate cancer. Our data suggest that surgical treatment can result in long-term progression-free survival in a subset of carefully selected high-risk men. Further prospective studies are warranted to directly compare the outcomes of RP vs combined radiation and hormonal therapy in high-risk patients.
Authors: Patrick J Bastian; Mark L Gonzalgo; William J Aronson; Martha K Terris; Christopher J Kane; Christopher L Amling; Joseph C Presti; Leslie A Mangold; Elizabeth Humphreys; Jonathan I Epstein; Alan W Partin; Stephen J Freedland Journal: Cancer Date: 2006-09-15 Impact factor: 6.860
Authors: Stephen J Freedland; Alan W Partin; Elizabeth B Humphreys; Leslie A Mangold; Patrick C Walsh Journal: Cancer Date: 2007-04-01 Impact factor: 6.860
Authors: Christopher J Kane; Joseph C Presti; Christopher L Amling; William J Aronson; Martha K Terris; Stephen J Freedland Journal: J Urol Date: 2007-01 Impact factor: 7.450
Authors: Anthony V D'Amico; Judith Manola; Marian Loffredo; Andrew A Renshaw; Alyssa DellaCroce; Philip W Kantoff Journal: JAMA Date: 2004-08-18 Impact factor: 56.272
Authors: Thomas Wiegel; Dirk Bottke; Ursula Steiner; Alessandra Siegmann; Reinhard Golz; Stephan Störkel; Norman Willich; Axel Semjonow; Rainer Souchon; Michael Stöckle; Christian Rübe; Lothar Weissbach; Peter Althaus; Udo Rebmann; Tilman Kälble; Horst Jürgen Feldmann; Manfred Wirth; Axel Hinke; Wolfgang Hinkelbein; Kurt Miller Journal: J Clin Oncol Date: 2009-05-11 Impact factor: 44.544
Authors: A V D'Amico; R Whittington; S B Malkowicz; D Schultz; K Blank; G A Broderick; J E Tomaszewski; A A Renshaw; I Kaplan; C J Beard; A Wein Journal: JAMA Date: 1998-09-16 Impact factor: 56.272
Authors: Benjamin T Ristau; Jeffrey J Tomaszewski; Yi-Fan Chen; Marnie Bertolet; Elen Woldemichael; Joel B Nelson Journal: World J Urol Date: 2014-11-01 Impact factor: 4.226
Authors: Phillip M Pierorazio; Ashley E Ross; Brian M Lin; Jonathan I Epstein; Misop Han; Patrick C Walsh; Alan W Partin; Christian P Pavlovich; Edward M Schaeffer Journal: BJU Int Date: 2012-02-28 Impact factor: 5.588