RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE-CANCER - LONG-TERM RESULTS OF 1,143 PATIENTS FROM A SINGLE INSTITUTION

Purpose: To determine the efficacy and complication radical prostatect omy (RP) as a treatment option for clinically localized prostate cance r (clinical stage less than or equal to T2c). Methods: The study was a retrospective analysis of 1,143 consecutive patients (median age, 64 years; range, 38 to 79 y) who underwent RP at one institution (mean fo llow-vp time, 9.7 years). Complications for this study population were compared with those of a contemporary group of 1,000 consecutive pati ents. Results: Of 1,143 patients, 83 (7%) had a low clinical stage (T1 ) and 160 (14%) had a low histologic grade (Gleason score less than or equal to 3); 648 (57%) had a high clinical stage (T2b or T2c) and 204 (18%) had a high histologic grade (Gleason score greater than or equa l to 7). Only 113 (10%) died of prostate cancer, and 177 (15%) develop ed metastasis. Adjuvant treatment (androgen deprivation or radiation t herapy) was given in 197 (17%) patients (greater than or equal to pT3) and provided virtually identical results as without adjuvant treatmen t. The 10- and 15-year crude survival rates for 1,143 patients were 75 % +/- 1.5% (SE) and 60% +/- 2.2%, respectively; the cause-specific sur vival rates were 90% +/- 1.1% and 83% +/- 1.9%, respectively; and the metastasis-free survival rates were 83% +/- 1.3% and 77% +/- 1.9%, res pectively (398 men at risk at 10 years and 138 men at risk at 15 years ). The 10-year survival rate for patients with Gleason score greater t han or equal to 7 was 74% +/- 3.9%. Only tumor grade was a significant predictor for disease outcome. The hospital mortality rate decreased from 0.7% for the 1,143 study patients to 0% for the more recent 1,000 patients. Severe incontinence declined to 1.4% for the more recent 1, 000 patients. Most patients who underwent RP were healthy (Charlson co morbidity index). Conclusion: Survival at 15 years was similar to the expected survival rate. Current morbidity and mortality rates associat ed with Rp were extremely low. Thus, RP has been a viable management o ption for men with clinically localized prostate cancer who have a lif e expectancy of more than 10 years. (C) 1994 by American Society of Cl inical Oncology.