Fifteen-year data on radical prostatectomy as part of multimodal therapy for clinically advanced prostate cancer indicate that long-term survival after surgery may be as high as 80 percent in these men, according to an article in the April issue of the British Journal of Urology International.

“These patients have a better chance if they undergo surgery and are living longer than if they undergo radiation therapy,” said Horst Zincke, MD, PhD, Mayo Clinic urologist and senior study investigator.

Treatment of advanced prostate cancer has been controversial. Due to advanced stage, some physicians have considered it inoperable via radical prostatectomy, according to Zincke. He explained that many patients come to him for a second opinion after being told their cT3 prostate cancers could not be surgically removed.
“It’s considered inoperable by some urologists and referred to radiation oncology,” said Zincke. “They think surgery can’t be done because the cancer is outside the prostate. Currently, only 15 percent are referred for surgery.”

Five-year survival after radiation therapy as first-line treatment for cT3 prostate cancer, is 79 percent. In contrast, with radical prostatectomy, 79 percent of patients survived at least 15 years.

The cancer survival rates for cT3 prostate cancer with radical prostatectomy not only approach those of cT2 prostate cancer (cancer confined to the prostate), which is 90 percent at 15 years, but they are even more impressive due to the ages of the patients, said Zincke. “It’s significant because the average patient is only 62 years old,” he noted. “So, a 15-year survival is a long time.”

In addition to a favorable survival rate for the cT3 prostate cancer patients studied, the Mayo Clinic researchers also found urinary incontinence rates and complications were akin to those for cT2 prostate cancer.

Some of the patients studied with cT3 prostate cancer had additional, or adjuvant, therapy after surgery, such as hormone therapy or radiotherapy. Zincked indicates that adjuvant therapy is necessary for patients whose prostate cancer affects the lymph nodes. Surgery alone may be sufficient treatment for those without lymph node involvement. Approximately 50 percent of cases of cT3 prostate cancer do not involve the lymph nodes.

The study also found that 25 percent of the patients were over-staged -- told that they had a cT3 prostate cancer, a more advanced form, rather than what they really had, cT2 disease.

With more common use of prostate-specific antigen testing in the United States, more prostate cancers are now caught earlier, before the cancer spreads. Thus, the frequency of cT3 prostate cancers seen at Mayo Clinic has declined to 3 percent of all prostate cancers. Canada and Europe have much higher rates of cT3 prostate cancer because prostate antigen testing is not conducted as frequently and more cancers are discovered later than in the United States, allowing the cancers more opportunity to spread outside the prostate.

This study was conducted as a single-institution, retrospective study of 5,652 men who had radical prostatectomy at Mayo Clinic for confirmed prostate cancer.