Radical Prostatectomy Effective for Seminal Vesicle-Negative Locally Advanced Prostate Cancer

Chris Berrie, MA, MPhil, PhD

March 26, 2007

March 26, 2007 (Berlin) — Patients with locally advanced, pT3N0 prostate cancer are appropriate candidates for radical prostatectomy, although seminal vesicle invasion (pT3b) is associated with a significantly poorer prognosis, according to a presentation at the European Association of Urology 22nd Annual Congress.


"There remains a lot of controversy about how to treat patients with prostate cancer who present with locally advanced disease," Henrik Suttmann, MD, a resident in the Department of Urology and Pediatric Urology at Saarland University in Homburg/Saar, Germany, told Medscape. "The first problem is how to preoperatively identify them, and the second question is once you have locally advanced disease, how should you treat them."

The study included 530 patients from the last 10 years who had locally advanced disease on radical prostatectomy specimen. The investigators excluded patients who were lymph node–positive and they specifically compared patients without (pT3a) and with (pT3b) seminal vesicle invasion.

Patients were a median age of 64.6 years (range, 44-79 years), and 53.9% were undergoing postoperative androgen ablation therapy; 65.8% (n = 353) were pT3a and 34.2% (n = 183) were pT3b. Differences between pT3a and pT3b patients were seen for their mean prostate-specific antigen levels (13.6 ng/mL vs 25.5 ng/mL, respectively) and their Gleason scores of mainly 7 (74.3%) and 8 (12.5%) in the pT3a group compared with a wider spread of 7 (34.5%), 8 (19.5%) and 9 (37.1%) in the pT3b group.

At a mean follow-up of 37.2 months (median, 21.2 months), the pT3 (pT3a plus pT3b) patients' overall and disease-specific 10-year survival rates were 77% and 92%, respectively, and at 15 years, 52% and 75%. These results are similar to those of previous studies for overall survival of patients with advanced prostate cancer who undergo radical prostatectomy.

However, in the present study, Dr. Suttmann said, "The main issue is that you have 10-year disease-specific survival for those with pT3a of 92%, which is probably as much as those with pT2 tumors, while disease-specific survival is much worse for those who have pT3b disease, and so have seminal vesicle involvement."

Although Dr. Suttmann indicated that they had not included any specific analysis for prognostic factors, he said, "We would still conclude that radical prostatectomy [with or without hormonal therapy] is a pretty good therapeutic option for those with pT3 disease."

The study was independently funded, and the authors report no relevant financial relationships.

EAU 22nd Annual Congress: Abstract 123. Presented March 21, 2007.

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