Radical prostatectomy can provide a cure for well-selected clinical stage T3 prostate cancer

Objective: Radical prostatectomy is commonly believed not to achieve the er adication of locally advanced disease. This retrospective study aimed to el ucidate the role of radical prostatectomy in this condition. Methods: A retrospective study of 158 patients surgically treated for clini cal stage T3N0M0 prostate cancer was undertaken. Thirty patients had postop erative hormonal treatment, rendering prostate-specific antigen (PSA) follo w-up unreliable, and were considered to be progressive at 1 month. Eighteen other patients received postoperative radiotherapy. One hundred and ten pa tients had radical prostatectomy only. PSA-relapse-free survival was analyz ed. The mean follow-up time was 30 months. Results: Seventy-nine percent of the resected specimens were pathologically T3 (pT3), and about 25% were pT3c. Thirteen percent were pT2 and 8% were p T4. Ninety-five specimens (60%) had positive surgical margins. There was po or accordance between the biopsy Gleason score and that of the specimen. A multivariate analysis showed that seminal vesicle and nodal invasion, margi n status and a PSA level above 10 ng/ml were independent prognostic factors . In 47 cT3a patients with PSA <10 ng/ml, the PSA-free survival rate exceed ed 70% at 24 months and the 5-year estimated PSA-free survival rate was mor e than 60%. Conclusions: Radical prostatectomy has a place in the treatment of clinical stage T3 prostate cancer patients with a PSA value lower than 10 ng/ml. Th ere is a need to definitively rule out nodal or seminal Vesicle invasion in order to select those patients that can benefit from surgery. Copyright (C ) 2000 S. Karger AG, Basel.