LONG-TERM (15 YEARS) RESULTS AFTER RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED (STAGE-T2C OR LOWER) PROSTATE-CANCER

To provide information about long-term outcome after radical prostatec tomy for clinically localized prostatic cancer (stage T2c or lower), w e undertook a retrospective analysis of 3,170 consecutive patients (me an age 65.3 +/- 6.4 years, range 31 to 81) with a mean followup of 5 y ears. Complication rates for patients who underwent prostatectomy befo re 1988 were compared with those who underwent radical prostatectomy m ore recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,0 47 (65%) had clinical stages Tla, T1b, T2a and T2b,c disease, respecti vely. The Gleason score was 3 or less in 292 patients (9%) and 7 or gr eater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of canc er. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76% , local recurrence-free survival rates 83% and 75%, overall recurrence -free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40% , respectively. Clinical stage did not significantly affect survival b ut tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less , 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, r espectively, for a score of 7 or more. Of all patients 26% received ad juvant treatment (hormonal and/or radiation) within 3 months postopera tively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1 ,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complic ations decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocar dial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary emb olism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600 mi., and the incidence of recent need for any transfusion was 31% and it is pr esently less than 5%. In this series patients undergoing radical prost atectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years co mpare favorably with those of an age-matched control group. Cause spec ific and metastasis-free survival rates are excellent, even for patien ts with undifferentiated cancer. Clinical tumor grade and co-morbidity , rather than clinical stage, are significant variables for survival o utcome. Present morbidity and mortality rates for radical prostatectom y are minimal.