Radical prostatectomy in T4 prostate cancer.

[pjoshea13]

New German study below.

T4 is cancer that has spread to nearby organs.

"To determine the outcomes of complete surgical resection of T4 prostate cancer (PCa) after inductive androgen deprivation treatment (ADT). An inductive ADT and subsequent radical prostatectomy (RP) is not recommended by any guideline yet."

"We retrospectively identified 116 patients treated between 2000 and 2014. At the time of diagnosis, median PSA was 37.6 ng/ml (range: 2.44-284 ng/ml). The preoperative median PSA after inductive ADT was 0.73 ng/ml (range: 0.01-34 ng/ml). Thereafter, patients underwent RRP {radical prostatectomy} or, since 2006, RALP {robot-assisted laparoscopic prostatectomy }. The median overall survival was 156 mo .... The cancer-specific survival at 150 months was 82%."

-Patrick

ncbi.nlm.nih.gov/pubmed/297...

BJU Int. 2018 May 17. doi: 10.1111/bju.14393. [Epub ahead of print]

Radical prostatectomy in T4 prostate cancer after inductive androgen deprivation: Results of a single-institution series with long-term follow up.

Hajili T1, Ohlmann CH1, Linxweiler J1, Niklas C1, Janssen M1, Siemer S1, Stoeckle M1, Saar M1.

Author information

1

Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany.

Abstract

OBJECTIVES:

To determine the outcomes of complete surgical resection of T4 prostate cancer (PCa) after inductive androgen deprivation treatment (ADT). An inductive ADT and subsequent radical prostatectomy (RP) is not recommended by any guideline yet.

PATIENTS AND METHODS:

A monocentric RP database was queried for patients initially diagnosed with T4 PCa, considered as primary inoperable because of a fixed mass defined by rectal examination in combination with high PSA and/or large foci of biopsy-proven undifferentiated PCa. Treatment consisted of primary ADT until PSA nadir with consecutive prostatectomy. Patients underwent retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic prostatectomy (RALP) after inductive ADT until achievement of the PSA nadir, which is in general reached after 6-7 months. The intraoperative course and complications were analysed. Finally, Kaplan-Meier estimates were calculated for overall and prostate-cancer specific survival.

RESULTS:

We retrospectively identified 116 patients treated between 2000 and 2014. At the time of diagnosis, median PSA was 37.6 ng/ml (range: 2.44-284 ng/ml). The preoperative median PSA after inductive ADT was 0.73 ng/ml (range: 0.01-34 ng/ml). Thereafter, patients underwent RRP or, since 2006, RALP. The median overall survival was 156 mo (95% CI, 118.9-193.1). The cancer-specific survival at 150 months was 82%.

CONCLUSIONS:

Surgical therapy of primarily inoperable PCa is feasible and safe after inductive ADT. Overall survival of this cohort seems comparable with results described for patients with primary operable high risk PCa. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS:

Inductive androgen deprivation; inoperable high risk prostate cancer; prostate specific antigen nadir; radical prostatectomy

PMID: 29772100 DOI: 10.1111/bju.14393

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To pjoshea, There seems to be a bone of contention about this issue.. As one that was not a candidate for RP , I don’t believe nor has any Doctor ever recommended or even hinted that this would ever come up for someone that had my exact condition .. Definate in my my mind. I will never be offered surgery.. I’m told . No point. Removing the prostate does not promise anything to a patient as urological twisted as I was.. Docs now tell me that my once “ Gigantic “ prostate has shurunken and obliterated with ADT & RT . Not much left of the prostate ... for me that’s the best news possible. Thanks for posting.. TGIF.... take care.

[snoraste]

Patrick,

Interesting article, but I'm not entirely clear on the terminology. It seems to be evaluating "operable high risk" vs "un-operable T4", no? And the term "un-operable" in T4, is that a subgroup or pretty much a majority of the T4 patients based on description?

Even in the narrowest definition of the terms, the article points to a positive outcome - should be read as yet another encouraging sign for combining local + systemic if tolerated.

[joancarles]

Do you consider that this article is feasible with bone metastasis?

[pjoshea13 in reply to joancarles]

There seems to be growing interest in debulking. From what some in the group have reported, some doctors are agreeable to removing the prostate when there are metastases.

-Patrick