Long-Term Oncological Outcomes of High-Risk Prostate Cancer defined by Histopathological Examination.

BACKGROUND: The optimal treatment modality for locally advanced prostate cancer has not been established. Radiotherapy, hormonal therapy, and combinations of treatments are the main strategies, although the feasibility of radical prostatectomy as a first-line therapy needs to be considered. This retrospective study evaluated the long-term oncological outcome of high-risk prostate cancer treated surgically, using pathological results of the extracted specimen. The relationship between the number of risk factors and the long-term outcome was specifically analyzed.

METHODS: High-risk prostate cancer patients who underwent laparoscopic radical prostatectomy at Nippon Medical School from 2000 to 2012 without neoadjuvant therapy of any kind were identified. Risk factors were prostate-specific antigen (PSA) ≥20 ng/ml, pathological ≥T3, and pathological Gleason Score ≥8. Biological failure was defined as PSA ≥0.2 ng/ml.

RESULTS: A total of 222 men were identified. One patient had positive lymph node status, and there was a significant difference in surgical margin positivity (52 men, 68.4% vs 56 men 38.4%) between patients with and without biochemical failure. For patients meeting the high risk criteria with a follow-up of up to 133 months, the biochemical recurrence (BCR) -free survival rates at 5 and 10 years were 62.8% and 58.4%, respectively, with a mean time to BCR of 14.0 months. BCR-free survival rates at 5 and 10-year were 73.6% and 71.4%, respectively, with 1 risk factor, 48.7% and 34.6%, respectively, with 2 factors, and 34.5% and 34.5%, respectively, with 3 factors. A single risk factor group had a significantly better outcome than the group with multiple risk factors. The overall survival rate at 5 and 10 years were 94.6% and 93.7%, and the cancer-specific survival rate was 100% at both 5 and 10 years.

CONCLUSIONS: Reasonable long-term oncological outcomes can be achieved by surgical treatment for high-risk prostate cancer. The group with 1 risk factor had a significantly better BCR-free rate than the multiple risk factor group.