Radical Prostatectomy in High-Grade Prostate Cancer, Salvage and Adjuvant Radiotherapy

Abstract

Introduction: Prostate cancer with a Gleason score (GS) of 8–10 is linked to a higher risk of recurrence and progression. The aim of this paper is to evaluate treatment results of our high-risk patient cohort.Patients and Methods: The cohort of 42 patients with radical prostatectomy (RP) specimen histology GS 8–10 was assessed. The patients were followed up after RP and radiotherapy (RT) was delivered in case of a biochemical relapse. Adjuvant radiotherapy (aRT) was delivered only in case of a positive surgical margin (PSM). The following parameters were evaluated: biochemical progression-free survival (BPFS), overall survival (OS) and cancer-specific survival (CSS). The second objective was to evaluate adverse effects of RP and RT. Results: The median follow-up time was 88 months (18–168). RP led to BPFS in 16 patients (38%). Five patients with PSM underwent aRT and 20 underwent salvage radiotherapy (sRT). One patient died of myocardial infarction and 1 patient died of metastatic disease. Skeletal metastases were recorded in 2 patients. The BPFS in RP combinations with sRT or aRT was reached in 29 patients (69%). The OS and CSS in our cohort reached 95 and 98%, respectively. Conclusion: Management with aRT only in PSM was very effective, according to our retrospective study.

Radiation-Induced Secondary Malignancy in Prostate Cancer: A Systematic Review and Meta-Analysis

“…Because of a trend toward diagnosing prostate cancer at a younger age and earlier stage [2,3] and increasingly successful treatment options [4,5,6], the number of prostate cancer survivors is expected to continue to rise. Since 10-year survival rates for prostate cancer exceed 80% [7], most men will survive their disease and be at risk of experiencing negative consequences of therapy.…”

High‐dose rate brachytherapy compared with open radical prostatectomy for the treatment of high‐risk prostate cancer: 10 year biochemical freedom from relapse

“…Even experienced surgeons report a PSM rate of 30–50% for higher risk disease [8]. Nevertheless, there is an increasing trend amongst surgeons towards RP for high‐risk disease [9,10]. More recently a multimodality approach with adjuvant EBRT has gained favour after reports of benefit in patients with ECE, SVI or PSMs [11].…”