LONG-TERM OUTCOME IN PATIENTS WITH PTXN+ ADENOCARCINOMA OF PROSTATE TREATED WITH RADICAL PROSTATECTOMY AND EARLY ANDROGEN ABLATION

Purpose: We assessed retrospectively the outcome after bilateral pelvi c lymphadenectomy and radical prostatectomy for pathological pTxN+ ade nocarcinoma of the prostate when treated with or without adjuvant andr ogen ablation therapy. Materials and Methods: A total of 790 men treat ed with radical prostatectomy for prostatic adenocarcinoma were found to have pTxN+ disease and treated further with or without androgen abl ation therapy. Mean patient age was 64 years (range 40 to 79). Mean fo llowup was 6.5 years, (range up to 25). Clinical stages were T2 or les s in 60% of the cases, T3 in 38% and N+ in 2%. Gleason scores were 6 o r less in 31% and 7 or greater in 69%. Deoxyribonucleic acid ploidy wa s diploid in 43%, tetraploid in 39% and aneuploid in 18%. Of the patie nts 96 (12%) received no androgen ablation therapy, with the remainder getting androgen ablation therapy within 90 days of radical prostatec tomy. Results: Of the patients 186 (24%) died, with 109 (14%) dying of prostatic anedocarcinoma. Overall (and cause specific) survival proba bilities at 5, 10 and 15 years were 87 (91), 69 (79) and 39% (60%), re spectively. Patients with diploid tumors had better cause specific sur vival than those with nondiploid tumors (p = 0.009). Patients with dip loid tumors were less likely to have progression biochemically, locall y or systemically than those with nondiploid tumors (p = 0.038). Andro gen ablation therapy had no effect on cause specific survival in nondi ploid patients. Diploid patients treated with androgen ablation therap y for up to 10 years had no improvement in disease specific survival c ompared to those with no androgen ablation therapy. However, cancer de ath was significantly reduced after 10 years (p < 0.002). The local co ntrol rate of pTxN+ cases that receive radical prostatectomy and andro gen ablation therapy at 15 years is virtually identical to that of sta ge pT2c cases at our institution (79 +/- 3.0 versus 80% +/- 3.5%, resp ectively). There were no deaths secondary to radical prostatectomy, an d complications were within the experience of that seen in patients wi th localized disease. Conclusions: Radical prostatectomy with androgen ablation therapy is a viable option for patients with pTxN+ disease, particularly in view of excellent local control rates and low morbidit y. Patients with diploid tumors have a more favorable outcome than tho se with nondiploid tumors when treated with androgen ablation therapy.