Radical prostatectomy in high-risk prostate cancer: incidence of specimen-confined disease (pT2-pT3a N0R0) and outcomes

INTRODUCTION:Radical prostatectomy (RP) in patients with high-risk prostate cancer (PC) [prostate specific antigen (PSA) ≥20 ng/mL, and/or Gleason score ≥8, and/or cT3a disease] is considered an optional therapy, usually as a part of multimodal approach. Aim of the study is to evaluate the outcome of radical prostatectomy in case of specimen-confined (SC) disease and to compare it with patients with pathological locally-advanced disease.MATERIALS AND METHODS:Data from 176 consecutive patients with high-risk prostate cancer who underwent RP as initial therapy were analyzed, identifying subjects with specimen-confined disease (i.e. negative margins and negative lymph-nodes) in which RP was considered as monotherapy, and comparing oncological outcomes to patients with pathological non-SC disease, in which RP was considered as the first step of a multimodal approach.RESULTS:In high-risk prostate cancer, pathological report showed the presence of specimen-confined disease in 28.3% of cases. At univariate analysis, age and PSA correlate with the presence of SC disease at radical prostatectomy, while at multivariate analysis only PSA was a significant predictor of SC disease. At 5 years, Kaplan-Meier estimation of biochemical-free and cancer-specific survival was 56.2% and 97.7% vs 40.8% and 92.8% in specimen-confined disease and non-specimen-confined disease, respectively.CONCLUSIONS:High-risk prostate cancer presents challenges for uro-oncologists since standard treatment is still under debate. One third of patients will present with specimen-confined disease, for which radical prostatectomy represents the sole, initial curative therapy; RP as multimodal therapy in patients without SC disease permits excellent long-term oncological outcomes.