Study Supports Surgery for High-Risk Prostate Cancer

Radical prostatectomy (RP) is associated with excellent long-term outcomes in patients with high-grade prostate cancer (PCa), according to researchers.

In a study of 30,379 men (mean age 62.5 years) who underwent RP for Gleason 8-10 non-metastatic PCa, Naveen Pokala, MD, and colleagues at the University of Missouri-Columbia School of Medicine in Columbia found that the overall survival rates at 5, 10, 15, 20, and 25 years were 92.8%, 78.6%, 59.5%, 38.6%, and 20.0%, respectively. Cancer-specific survival rates were 96.4%, 89.5%, 82.0%, 72.9%, and 68.8%, respectively, the researchers reported online ahead of print in the World Journal of Urology.

“This is the first study to demonstrate excellent 20-year cancer-specific survival of men with Gleason 8-10 prostate cancer,” the authors wrote.

A total of 52.8% of patients had T2 disease, 73% had node-negative disease, 80.2% underwent lymph node dissection, and 12.9% had adjuvant radiation therapy. The study showed that pelvic lymph node dissection did not significantly affect overall survival.

Dr. Pokala's group noted that some urologists are reluctant to offer RP as a treatment for high-risk disease because of the higher incidence of lymph node metastasis, local and systemic recurrence, and poor survival. They cited an investigation from the Cancer of the Prostate Strategic Urological Research Endeavor disease registry showing that patients with Gleason 8-10 PCa were nearly twice as likely to have external beam radiation treatment and four times as likely to receive primary androgen deprivation therapy as they were to undergo surgery.

The researchers cited previous studies showing that, for patients with Gleason 8-10 disease, RP is associated with a significantly lower risk of cancer-specific death compared with conservative management or radiotherapy.

With regard to study limitations, Dr. Pokala and colleagues noted that they analyzed data from a cancer database representing many institutions, so there was no standardization with regard to how pathologic specimens were interpreted.

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