Primary surgical therapy for clinical stage T3 adenocarcinoma of the prostate.

Semin Urol Oncol 1997;15(4):215-21

Amling CL; Leibovich BC; Lerner SE; Bergstralh EJ; Blute ML; Myers RP; Zincke H
Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.

Radical prostatectomy has not been a widely accepted treatment option
in patients with clinical stage T3 prostate cancer due to the
potential for incomplete excision of tumor and the high incidence of
lymph node metastases. In addition, the morbidity of surgical therapy
in these patients has been questioned. As a result, alternative
treatment modalities, including androgen ablative therapy and
radiotherapy, are often used in patients with locally advanced
disease. However, in terms of local disease control and long-term
disease-free survival rates, most alternative treatments have serious
limitations in clinical stage T3 tumors. We recently reported our
extended experience with radical prostatectomy and adjuvant therapy
in a large group of patients with clinical stage T3 disease and this
article updates that experience. Although 31% of patients in our
series had node-positive disease, 25% had pathologically organ-
confined tumors likely to be cured by surgical therapy alone.
Cancer-specific survival rates at 5, 10, and 15 years were 93%, 84%,
and 74%, respectively, and operative morbidity paralleled that of
patients with clinically localized disease. Our experience suggests
that excellent long-term survival with low treatment-related
morbidity can be achieved with radical prostatectomy and adjuvant
therapy in patients with clinical stage T3 prostate cancer. (42 Refs)