Radical prostatectomy in men with high risk prostate cancer: Long by 31sY3c3

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									Radical prostatectomy in men
with high risk prostate cancer:
     Long term outcome.

  A B Stewart, M H Khan, P Koenig, N A Shaikh

           Airedale General Hospital
Risk stratification criteria for men with
localised prostate cancer
          Review of Literature
• 61 year old man. PSA 22. Gleason 4 + 4. MRI T3. Fit and well.

• How do we counsel patients with high risk prostate cancer?

• What is the 5 year biochemical progression free rate with ERBT +/-
  hormones for high risk ca prostate?

• What is the 5 year biochemical progression free rate with RRP for
  high risk ca prostate?

Scardino et al (MSK) 1
    – 176 T3 RRP’s from 1983-2003
    – At 6.4 years 52% biochemical progression free
    – 6 % death at 5 years



                                           1. J Urol 2006;176(2):564-8
EBRT and Hormonal Therapy




             Bolla et al Lancet 2002;360:103
                   Objectives
  To report long term cancer outcomes in patients
   undergoing radical prostatectomy for high risk
   prostate cancer at Airedale General Hospital
                    Methods
 A retrospective review of all 137 patients having
  radical prostatectomy between 1994 and 2003
  identified 38 with high risk prostate cancer
                    Results
• Age: Mean 61, Range 44-71
• Pre op PSA: Median 22, Range 5.8-233
• Mean follow up period: 94 months, Range 60-
  167 months
                          Results
            Pre Op     Post Op                      Pre Op     Post Op
PSA <10     8 (23%)               Stage
PSA 10-20   9 (27%)               T1                7 (22%)    0
PSA >20     17 (50%)              T2                14 (44%)   9 (27%)
                                  T3                11 (34%)   70%
Gleason                           T3a                          -13
Sum
<6          2 (6%)     2 (7%)     T3b                          -10

6           4 (12%)    1 (3%)     T4                           1 (3%)

7           7 (22%)    7 (24%)
8           13 (41%)   8 (28%)    N1                           2 (6%)

9           6 (19%)    11 (38%)
                                  Positive Margin              23 (70%)
                              Results
                         38 RRP (3 lost to follow up)



                                35 RRP


                 16 No EBRT                   19 EBRT


                               8 Immediate        11 For PSA
                               prophylactic       recurrence



Disease free         9                5                 4      18 (51%)
PSA recurrence       5                3                 6      14 (40%)
CAP death            2                0                 1       3 (9%)
              Conclusion
• Our findings strongly support the opinion
  that radical prostatectomy has a positive
  role, with or without adjuvant therapies, in
  managing men with high risk prostatic
  adenocarcinoma.

								
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