Results of radical prostatectomy in newly diagnosed prostate cancer: long-term survival rates in locally advanced and high-risk cancers.

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSION: 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%.