RESULTS OF RADICAL PROSTATECTOMY IN MEN WITH LOCALLY ADVANCED PROSTATE-CANCER - MULTIINSTITUTIONAL POOLED ANALYSIS

Objective: We investigated the disease-specific and metastasis-free su rvival rates in men with locally advanced (clinical stage T3) prostate cancer who were treated surgically, Methods: A retrospective, multi-i nstitutional pooled analysis of the results of surgical treatment in 3 45 men with clinical stage T3 disease was performed, Survival curves w ere generated using the Kaplan-Meier method. Results: Among 298 evalua ble patients, pelvic lymphadenectomy alone was performed in 56 men (19 %), while 242 men (81%) underwent node dissection and radical prostate ctomy. In total, 122 of 298 patients (41%) had nodal metastases and/or seminal vesicle tumor spread, Pathologically organ-confined disease w as noted in 27 men (9%). The actuarial 10-year disease-specific and me tastasis-free survival rates for all patients managed surgically were 57 and 32%, respectively, For patients with well, moderately and poorl y differentiated tumors, cancer-specific survival rates at 10 years we re 73, 67 and 29%, respectively. Conclusions: A large number of men wi th clinical stage T3 prostate cancer have advanced disease and are unl ikely to achieve improved longterm survival with surgery alone. Althou gh there may be a role for radical prostatectomy in selected patients with low to intermediate grade tumors, such treatment appears unlikely to result in long-term survival in men with high grade disease, A pro spective study is necessary to determine the optimal treatment approac h in men with locally advanced prostate cancer.