[Oncologic and functional outcomes after radical prostatectomy in T3 prostate cancer]

[Outcomes of radical prostatectomy in patients with prostate cancer at the Aristide Le Dantec University Hospital]

Le but était d´évaluer les résultats carcinologiques de la prostatectomie radicale. Il s´agissait d´une étude rétrospective monocentrique au service d´urologie-andrologie de l´Hôpital Aristide Le Dantec de Dakar du 1^er juin 2010 au 31 mai 2016. Nous avons colligé 60 cas de prostatectomie radicale par voie rétropubienne associée à un curage ganglionnaire ilio-obturateur. Après la prostatectomie radicale (PR), le taux d’antigène prostatique spécifique (PSA) était indétectable (<0,1 ng/ml) chez 20 patients (33,3%). Onze malades (18,3%) qui avaient une récidive biochimique, ont une hormonothérapie complémentaire. Une réponse a été obtenue après instauration du traitement avec un taux de PSA total redevenu indétectable après un suivi de 8 mois. La durée moyenne de la survie globale était de 17,5 mois avec une médiane de 9,49. Le taux de survie globale cumulé à 1 an, 3 ans et 4 ans étaient respectivement de 42,4, 13,6 et 6,8%. La durée moyenne de la survie sans récidive était de 17,3 mois avec une médiane de survie sans récidive biochimique qui était de onze (11) mois. La durée moyenne de la survie spécifique était de 8,1 mois avec une médiane de 3 mois. Les marges de résection étaient positives chez sept (7) patients soit un taux de 11,6%. Quatre(4) patients avaient un envahissement ganglionnaire. La prostatectomie radicale indiquée dans quelques cas dans notre pratique, est une méthode thérapeutique efficiente avec de bons résultats carcinologiques.

[Long-term outcomes of prostate cancer patients with lymph nodes metastasis after radical prostatectomy and pelvic lymph node dissection]

INTRODUCTION

The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cN0) and pelvic lymph node metastasis (pN+) treated with radical prostatectomy and pelvic lymph node dissection.

PATIENTS AND METHODS

This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients.

RESULTS

Thus, 30 patients were included. Median follow-up was 89.9±27.4 months. After surgery, patients were treated with surveillance (n=4, 13.5%), adjuvant hormone therapy (n=22, 73%) or combination of radio and hormone therapy, (n=4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38±30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P=0.00021) and pathological margin status (P=0.0065) were independent predictors of 5-year RFS.

CONCLUSION

Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS.

LEVEL OF EVIDENCE

4.

[Oncological outcomes of prostate cancer surgery]

OBJECTIVE

Review of the oncological results of the radical prostatectomy as initial treatment of prostate cancer, according to the surgical approach and the risk stratification using D'Amico risk groups.

MATERIALS AND METHODS

Review of literature using Medline databases and MedScience based on scientific relevance. Research focused on the oncological results of the radical prostatectomy in series and meta-analysis published since 10 years, taking into consideration the surgical approach if mentioned.

RESULTS

The characteristics of the operated tumor highly impact the local control authenticated by the pathologic stage and the rates of positive surgical margins (PSM), in addition to the survival and the biochemical recurrence. Surgical technique adapted according to the tumor treated, was a constant challenge to the urologist, who counter balance between the oncological control and the conservation of urinary and sexual function by conditioning the type of radical prostatectomy. Results of radical prostatectomy acceptable in terms of PSM and survival are not influenced by the surgical approach but by the degree of surgical experience.

CONCLUSION

Results of radical prostatectomy show the efficient local control of prostate cancer, taking into consideration the oncological rules and indications validated by multidisciplinary meetings, based on the national (CCAFU) and European oncological guidelines. Tendency is going toward considering radical prostatectomy indicated for patients with higher risk of disease progression, so integrating surgery in a multidisciplinary personalized approach.

[pT3N0 prostate cancer treated with radical prostatectomy as sole treatment: Oncological results and predictive factors of recurrence]

OBJECTIVES

To evaluate biological free survival in patients with locally advanced prostate cancer treated with radical prostatectomy (RP) as sole treatment, and to analyse predictive factors of recurrence.

PATIENTS AND METHOD

We retrospectively studied patients treated between 1996 and 2006 for a pT3N0 prostate cancer with RP without any adjuvant treatment. The main endpoint was PSA relapse, defined as two successive elevations of PSA>0.2 ng/mL. An association between PSA free survival and PSA, Gleason score, pathological stage and surgical margins status was statistically assessed.

RESULTS

A total of 147 patients were included. Median preoperative PSA was of 10 ng/mL. Pathological stage was pT3b in 30% of the cases and surgical margins showed cancer involvement in 63% of the cases. Gleason score was ≥3+4 in 74% of the cases. Postoperative PSA was undetectable in 121 (82%) patients. Median follow up following RP was of 5 years. The 5-year-PSA free survival was of 48%. Multivariate analysis showed that preoperative and postoperative PSA, as well as Gleason score were predictors of PSA relapse (P<0.05). In patients with undetectable postoperative PSA, 5-year-PSA free survival was of 56%. Seminal vesicle involvement and Gleason score ≥3+4 were the only independent predictors of PSA relapse.

CONCLUSIONS

After RP for pT3N0 prostate cancer, the only predictive factors of recurrence were postoperative PSA and Gleason score. In case of undetectable postoperative PSA, surveillance seems acceptable if Gleason score is <3+4 and in the absence of seminal vesicle involvement.