The gold standard treatment for clinical stage T3 prostate cancer has long been the combination of radiotherapy and extended hormone therapy. However, the accuracy of clinical staging based on DRE is open to some question, since 20 percent of patients assessed to have cT3 prostate cancer today appear to be over-staged during physical examination.
Xylinas et al. have reviewed available data on the surgical management of cT3 prostate cancer and compared the available data to the current EAU guidelines.
In the authors’ opinion, magnetic resonance imaging (MRI) is now an essential element of clinical staging for suspected T3 disease to evaluate risk for extraprostatic extension during preoperative work-up.
They note that the EAU guidelines recommend radical prostatectomy only in selected patients with T3 disease: specifically those with clinical stage ≤ cT3a, a PSA value < 20 ng/ml, and a biopsy Gleason score ≤ 8.
Based on their review of the available data, they report that there is significant variation in outcomes between the available published series of surgical patients with cT3 disease:
- Biochemical free survival rates at 5, 10 and 15 years range between 45 and 62, 43 and 51, and 38 and 49 percent respectively.
- Cancer-specific survival rates at 5, 10 and 15 years are between 84 and 98, 85 and 91, and 76 and 84 percent, respectively.
- Surgical margins rate vary from 22 up to 61 percent depending on operative technique and the surgeon’s personal experience.
The authors state that, with respect to adverse effects of treatment, urinary continence outcomes are comparable to those following prostatectomy for localized prostate cancerand rates of erectile dysfunction correlate with the type of surgery. They suggest that there appears to be no impact on overall or prostate cancer-specific survival of neoadjuvant treatments.
They conclude that radical prostatectomy can now be considered as a viable, alternative, first-line treatment option for carefully evaluated patients with cT3 disease. They add, however, that patients should be cautioned about the potential need for adjuvant therapies during the postoperative course of their disease. They also comment that the potential value of early adjuvant radiation therapy (as compared to salvage radiation) is still not fully resolved.
Filed under: Management, Treatment Tagged: | cT3 disease, Europe, surgical treatment
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