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Radical prostatectomy for clinical stage T3a disease.
Cancer. 2007 Apr 01; 109(7):1273-8.C

Abstract

BACKGROUND

Men with clinical stage T3a disease are at high risk and are often encouraged to undergo radiation therapy with concomitant hormonal therapy. The long-term outcomes among men treated with radical prostatectomy for clinical stage T3a disease were examined.

METHODS

Among 3397 men treated by radical prostatectomy by 1 surgeon between 1987 and 2003, 62 (1.8%) men were identified who had clinical stage T3a disease. Among the 56 men not treated with neoadjuvant or adjuvant therapies before prostate-specific antigen (PSA) recurrence, the long-term outcomes of PSA-free survival, metastasis-free survival, and prostate cancer specific survival were examined. Median and mean follow-up after surgery were 10.3 and 13 years, respectively (range, 1-17).

RESULTS

Ninety-one percent of men in this group had pathological T3 disease. PSA-free survival at 15 years after surgery was 49%. Metastasis-free survival and cause-specific survival at 15 years after surgery were 73% and 84%, respectively. Among men with a PSA recurrence, 46% received secondary therapy before metastasis. The only preoperative or pathological feature that predicted risk of prostate cancer death was lymph node metastasis (hazard ratio [HR]: 9.22, 95% confidence interval [CI]: 1.06-80.02, P = .044). Among the 28 men with a PSA recurrence, PSA doubling time (PSADT) data were available for 23, of which 11 (48%) has a PSADT >/=9 months. No patient with a PSADT >/=9 months died of prostate cancer. A PSADT <9 months was significantly associated with increased risk of prostate cancer death (log-rank, P = .004).

CONCLUSIONS

In a select cohort of men with clinical stage T3a disease, radical prostatectomy alone provides long-term cancer control in about half of the men and results in a prostate cancer-specific survival of 84%. Among men with a PSA recurrence, PSADT at the time of recurrence is a useful determinant of risk of prostate cancer death.

Authors+Show Affiliations

Departments of Urology and Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA. steve.freedland@duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17315165

Citation

Freedland, Stephen J., et al. "Radical Prostatectomy for Clinical Stage T3a Disease." Cancer, vol. 109, no. 7, 2007, pp. 1273-8.
Freedland SJ, Partin AW, Humphreys EB, et al. Radical prostatectomy for clinical stage T3a disease. Cancer. 2007;109(7):1273-8.
Freedland, S. J., Partin, A. W., Humphreys, E. B., Mangold, L. A., & Walsh, P. C. (2007). Radical prostatectomy for clinical stage T3a disease. Cancer, 109(7), 1273-8.
Freedland SJ, et al. Radical Prostatectomy for Clinical Stage T3a Disease. Cancer. 2007 Apr 1;109(7):1273-8. PubMed PMID: 17315165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radical prostatectomy for clinical stage T3a disease. AU - Freedland,Stephen J, AU - Partin,Alan W, AU - Humphreys,Elizabeth B, AU - Mangold,Leslie A, AU - Walsh,Patrick C, PY - 2007/2/23/pubmed PY - 2007/5/2/medline PY - 2007/2/23/entrez SP - 1273 EP - 8 JF - Cancer JO - Cancer VL - 109 IS - 7 N2 - BACKGROUND: Men with clinical stage T3a disease are at high risk and are often encouraged to undergo radiation therapy with concomitant hormonal therapy. The long-term outcomes among men treated with radical prostatectomy for clinical stage T3a disease were examined. METHODS: Among 3397 men treated by radical prostatectomy by 1 surgeon between 1987 and 2003, 62 (1.8%) men were identified who had clinical stage T3a disease. Among the 56 men not treated with neoadjuvant or adjuvant therapies before prostate-specific antigen (PSA) recurrence, the long-term outcomes of PSA-free survival, metastasis-free survival, and prostate cancer specific survival were examined. Median and mean follow-up after surgery were 10.3 and 13 years, respectively (range, 1-17). RESULTS: Ninety-one percent of men in this group had pathological T3 disease. PSA-free survival at 15 years after surgery was 49%. Metastasis-free survival and cause-specific survival at 15 years after surgery were 73% and 84%, respectively. Among men with a PSA recurrence, 46% received secondary therapy before metastasis. The only preoperative or pathological feature that predicted risk of prostate cancer death was lymph node metastasis (hazard ratio [HR]: 9.22, 95% confidence interval [CI]: 1.06-80.02, P = .044). Among the 28 men with a PSA recurrence, PSA doubling time (PSADT) data were available for 23, of which 11 (48%) has a PSADT >/=9 months. No patient with a PSADT >/=9 months died of prostate cancer. A PSADT <9 months was significantly associated with increased risk of prostate cancer death (log-rank, P = .004). CONCLUSIONS: In a select cohort of men with clinical stage T3a disease, radical prostatectomy alone provides long-term cancer control in about half of the men and results in a prostate cancer-specific survival of 84%. Among men with a PSA recurrence, PSADT at the time of recurrence is a useful determinant of risk of prostate cancer death. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/17315165/Radical_prostatectomy_for_clinical_stage_T3a_disease_ L2 - https://doi.org/10.1002/cncr.22544 DB - PRIME DP - Unbound Medicine ER -