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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 focused 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.

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.

Oncologic outcomes

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, 1/3^rd 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.

Conclusions

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.

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NRL commentator, Daryl Brohman and Qantas CEO Alan Joyce both credit a simple PSA blood test for prostate cancer for saving their lives.

While Prostate Cancer is often associated with older men, Joyce was in his early forties and Brohman in his early fifties when they were diagnosed and treated.  Like many men with prostate cancer, neither man had shown any symptoms and consider themselves lucky their cancer was picked up before it was too late.

“We would encourage men to ask their GP about a PSA test for prostate cancer at around age 40,” says leading urological surgeon, Dr Paul Cozzi.

“There is increasing data suggesting that a baseline PSA (prostate specific antigen) blood test for men at around age 40 can predict both lifetime risk of developing cancer and raise a flag for potentially lethal cancers, which can be confirmed by a subsequent biopsy.”

Such an approach could help identify men at high risk who may benefit from early treatment or from an active surveillance regime,” says Dr Paul Cozzi.

Both the Urological Society of Australia and new Zealand and the Royal College of Pathologists  recommend men seek a test from the age of forty in consultation with their GPs.

“The message is now loud and clear that there is growing evidence showing that PSA tests save lives and that early detection is the key to reducing deaths from prostate cancer,” Dr Cozzi said.

Around 3,300 Australian men died from prostate cancer annually.

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