20-year survival after radical prostatectomy as initial treatment for cT3 prostate cancer
Menée sur 843 patients atteints d'un cancer de la prostate de stade cT3 traité entre 1987 et 1997 (durée médiane de suivi : 14,3 ans), cette étude évalue, du point de vue de la survie spécifique à 20 ans, l'efficacité d'une prostatectomie radicale en traitement initial
OBJECTIVE : To present long-term survival outcomes after radical prostatectomy (RP) for patients with cT3 prostate cancer, as the optimal treatment for patients with clinical T3 prostate cancer is debated. PATIENTS AND METHODS : We identified 843 men who underwent RP for cT3 tumours between 1987 and 1997. Survival was estimated using the Kaplan–Meier method. Cox proportional hazards regression models were used to evaluate the association of clinicopathological features with outcome. RESULTS : The median (range) postoperative follow-up was 14.3 (0.1–23.5) years. Down-staging to pT2 disease occurred in 26% (223/843) at surgery. Local recurrence-free, systemic progression-free and cancer-specific survival for men with cT3 prostate cancer after RP was 76%, 72%, and 81%, respectively, at 20 years. On multivariate analysis, increasing RP Gleason score (hazard ratio [HR] 1.8; P= 0.01), non-diploid chromatin content (HR 1.8; P= 0.01), positive surgical margins (HR 2.1; P= 0.007), and seminal vesicle invasion (HR 2.1; P= 0.005) were associated with a significant risk of prostate cancer death, while a more recent year of surgery was associated with a decreased risk of cancer-specific mortality (HR 0.88; P= 0.01) CONCLUSIONS : RP affords accurate pathological staging and may be associated with durable cancer control for cT3 prostate cancer, with 20 years of follow-up presented here. RP as part of a multimodal treatment strategy therefore remains a viable treatment option for patients with cT3 tumours.