What Are the Outcomes of Radical Prostatectomy for High-Risk Prostate Cancer?

Urology. 2010 Sep;76(3):710-4. doi: 10.1016/j.urology.2009.09.014. Epub 2009 Nov 22.


Objectives: To examine the long-term survival following radical prostatectomy in the population with high-risk prostate cancer. Despite considerable stage migration associated with widespread prostate-specific antigen screening, as many as one-third of incident prostate cancers have high-risk features. These patients are often treated with combined radiation and androgen deprivation therapy, and less is known about the long-term survival in this population after radical prostatectomy (RP).

Methods: Between 1992 and 2008, 175 men underwent RP by a single surgeon with D'Amico high-risk prostate cancer (clinical stage ≥T2c, biopsy Gleason score 8-10, or prostate-specific antigen >20 ng/mL). In this population, we examined the rates and predictors of biochemical progression, metastatic disease, and cancer-specific mortality.

Results: Among 175 high-risk patients, 63 (36%) had organ-confined disease in the RP specimen. At 10 years, biochemical recurrence-free survival was 68%, metastasis-free survival was 84%, and prostate cancer-specific survival was 92%. The 10-year rate of freedom from any hormonal therapy was 71%. Of the high-risk criteria, a biopsy Gleason score of 8-10 (vs ≤7) was the strongest independent predictor of biochemical recurrence, metastases, and prostate cancer death.

Conclusions: National data suggest that RP may be underutilized for the management of high-risk clinically localized prostate cancer. Our data suggest that surgical treatment can result in long-term progression-free survival in a subset of carefully selected high-risk men. Further prospective studies are warranted to directly compare the outcomes of RP vs combined radiation and hormonal therapy in high-risk patients.

MeSH terms

  • Adult
  • Aged
  • Humans
  • Male
  • Middle Aged
  • Prostatectomy* / methods
  • Prostatic Neoplasms / mortality*
  • Prostatic Neoplasms / surgery*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Time Factors
  • Treatment Outcome