Associate Professor Paul Cozzi recently presented long term results of surgery for high-risk prostate cancer at prestigious International meeting in Berlin,Germany.
The results of long term outcomes following surgery for High Risk Clinically Localised Prostate Cancer were presented at the Societe International D’Urologie meeting held in Berlinin October.
The address focussed on the results of a long term study of the oncologic and functional outcomes of surgery for this group of patients by Associate Professor Cozzi and his team at Urology Sydney over the last decade.
Patients undergoing surgery from 2000-2006 were selected from Associate Professor Cozzi’s prospective database of all surgical patients over the last decade, to allow minimum 5 years of observed rather than actuarial follow up to be analysed. The D’Amico classification of high risk disease (Clinical stage >T2c, PSA >20, Biopsy Gleason score 8-10) was used to identify patients for inclusion in the study.
A database of 179 high risk patients was identified with a median age of 63 (44-78); and a mean age of 62.87 was examined with validated questionnaire-based follow up of functional results and biochemical-free survival examined with a minimum 5 years of observed follow up.
Patients undergoing adjuvant or salvage treatments were classified as immediate failures. Overall 5 year biochemical free survival (PSA <0.2) was 71.25%. No patient has died from prostate cancer.
10% received salvage radiation with 64 % of these achieving a further durable biochemical response.
Eighty nine patients (50%) had pathological organ confined disease with negative margins achieved in 81%.
Down-staging from cT3 to pT2 disease occurred in 62.5 % with these patients expected to have more than 80% chance of long term cure by surgery alone.
Functional outcomes – potency and incontinence
Of patients who underwent nerve sparing, erectile function was preserved in 74%. Of these, 1/3rd required PDE-5 inhibitors to achieve an erection. Continence (no pads) was preserved in more than 90% of patients with only 5 requiring a further procedure to improve continence.
Excellent functional and oncologic outcomes can be achieved in experienced units for patients with high-risk clinically localised prostate cancer with almost three quarters achieving long term cancer control with minimal morbidity. Clinical staging is inaccurate and many men may be denied an opportunity for cure. Effective salvage treatments are available for those who are not cured by surgery alone.
These results appear superior to the reported results of androgen deprivation and radiation therapy for patients with high risk disease.