Radical retropubic prostatectomy for prostate cancer with microscopic bladder neck involvement: survival and prognostic implications

Abstract

RESULTSThe follow-up (median 7.2 years, mean 6.68, range 0.3-14) was available for 106 patients with microscopic bladder neck invasion. Seminal vesicle invasion was present in 69.8% of the cases, lymph node involvement in 29.2%, apex infiltration in 31.8%, and positive surgical margins in 23.6%. Biochemical progression occurred in 61 (57.5%) patients, and 25 of them died from cancer. The mean ( SD ) biochemical progression-free survival was 0.68 (0.05), 0.59 (0.05), 0.40 (0.05) and 0.38 (0.05) at 1, 2, 5 and 10 years, respectively. Age, Gleason score and lymph node invasion were independent prognostic factors on multivariate analysis. Overall and cancerspecific survival rates were 0.75 (0.04) and 0.80 (0.04) at 5 years and 0.57 (0.04) and 0.75 (0.04) at 10 years, respectively. Univariate analysis showed that seminal vesicle invasion, lymph node involvement and surgical Gleason score ≥ 8 significantly increased the risk of death. On multivariate analysis only the surgical Gleason score had an independent prognostic role with regard to overall survival ( P = 0.01; odds ratio 2.82, 95% confidence interval 1.2-6.4) and cancer-specific survival ( P < 0.001; 8.6, 2.5-28.8). CONCLUSIONSIn this series, overall and cancer-specific survival rates were comparable to those reported for surgically treated cT3 prostate cancers. The lack of need for external urinary diversion during the entire follow-up significantly contributed to the patients' quality of life.

Pelvic exenteration surgery in patients with locally advanced castration‐naïve and castration‐resistant, symptomatic prostate cancer

“…PES showed a long‐lasting benefit attributable to efficient tumour debulking in this patient cohort. Furthermore, patients did not need to undergo repetitive changes of endoluminal or percutaneous tubes, which has been shown to have a significant negative impact on quality of life [21,22].…”

Radikale pelvine Tumorchirurgie bei Patienten mit einem lokal fortgeschrittenen, symptomatischen kastrationsresistenten Prostatakarzinom

“…Die ppTC schaffte in dieser Patientenkohorte einen lang anhaltenden Nutzen durch effizientes Tumor-Debulking. Die Lebensqualität konnte durch das Fehlen von wiederholten Wechseln von Harnleiterschienen oder perkutanen Nephrostomien deutlich verbessert werden [ 17 , 18 ].…”