I have often had men recently diagnosed with advanced, metastatic prostate cancer call me and ask if surgery makes any sense for them to consider. I have never been sure how to respond given that their cancer is known to be already out of their gland. In response to this common question, researchers from the Mayo Clinic in Rochester, Minn., U.S had reported at a past American Urological Association (AUA) annual meeting that a radical prostatectomy (RP) for locally advanced prostate cancer (PCa) is technically feasible and is associated with good five- and 10-year outcomes.
Dharam Kauschik, M.D. headed a study of 87 men who underwent a RP and were found to have pT4 tumors. Their research included a median follow-up of about 10 years. Approximately 46% of the men presented with palpable extra-capsular disease. The estimated five-year rates of biochemical recurrence (BCR), systemic progression, and overall survival were 48%, 77%, and 91%, respectively. The five- and 10-year cancer-specific survival rates were 91% and 70%, respectively. Ten men (11.5%) had local recurrence. Forty men (46%) had node-positive disease on final pathology.
When they performed a multivariate analysis, they found that positive lymph nodes were associated with a twofold increased likelihood of BCR. Both positive lymph nodes and higher Gleason scores predicted systemic progression. This means that when considering surgery for a man newly diagnosed with advanced prostate cancer a serious look at lymph node status and Gleason Score should be factored into the surgery decision.
Dr. Kauschik’s team also evaluated surgical outcomes and matched them with combined radiotherapy and androgen deprivation therapy (ADT) and concluded that the outcomes were comparable. Newly diagnosed men with advanced, metastatic disease, a lower Gleason grade can now consider surgery as an alternative to radiation with ADT and anticipate similar 10 year outcomes. Men with positive lymph nodes and a higher Gleason grade will probably do better with radiation and ADT.
The next study we need would be combining surgery, radiation and ADT. We are waiting, Dr. Kauschik.