Long-Term (15 Years) Results After Radical Prostatectomy For Clinically Localized (Stage T2c Or Lower) Prostate Cancer

Abstract

No AccessJournal of Urology1 Nov 1994Long-Term (15 Years) Results After Radical Prostatectomy For Clinically Localized (Stage T2c Or Lower) Prostate Cancer Horst Zincke, Joseph E. Oesterling, Michael L. Blute, Erik J. Bergstralh, Robert P. Myers, and David M. Barrett Horst ZinckeHorst Zincke From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota Division of Urologie Surgery, Health Care International, Ltd., Beardmore St., Clydebank G81 4DY, Scotland More articles by this author , Joseph E. OesterlingJoseph E. Oesterling From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author , Michael L. BluteMichael L. Blute From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author , Erik J. BergstralhErik J. Bergstralh From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author , Robert P. MyersRobert P. Myers From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author , and David M. BarrettDavid M. Barrett From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)32399-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail To provide information about long-term outcome after radical prostatectomy for clinically localized prostatic cancer (stage T2c or lower), we undertook a retrospective analysis of 3,170 consecutive patients (mean age 65.3 ± 6.4 years, range 31 to 81) with a mean followup of 5 years. Complication rates for patients who underwent prostatectomy before 1988 were compared with those who underwent radical prostatectomy more recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,047 (65%) had clinical stages T1a, T1b, T2a and T2b,c disease, respectively. The Gleason score was 3 or less in 292 patients (9%) and 7 or greater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of cancer. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76%, local recurrence-free survival rates 83% and 75%, overall recurrence-free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40%, respectively. Clinical stage did not significantly affect survival but tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less, 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, respectively, for a score of 7 or more. Of all patients 26% received adjuvant treatment (hormonal and/or radiation) within 3 months postoperatively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complications decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocardial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary embolism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600ml., and the incidence of recent need for any transfusion was 31% and it is presently less than 5%. In this series patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years compare favorably with those of an age-matched control group. Cause specific and metastasis-free survival rates are excellent, even for patients with undifferentiated cancer. Clinical tumor grade and co-morbidity, rather than clinical stage, are significant variables for survival outcome. 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What should we think? What can we do?Journal of Urology, VOL. 152, NO. 5 Part 2, (1932-1938), Online publication date: 1-Nov-1994. Volume 152Issue 5 Part 2November 1994Page: 1850-1857 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsprostateprostatectomyMetricsAuthor Information Horst Zincke From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota Division of Urologie Surgery, Health Care International, Ltd., Beardmore St., Clydebank G81 4DY, Scotland More articles by this author Joseph E. Oesterling From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author Michael L. Blute From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author Erik J. Bergstralh From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author Robert P. Myers From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author David M. Barrett From the Department of Urology and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota More articles by this author Expand All Advertisement PDF DownloadLoading ...