Radical prostatectomy in the treatment of locally advanced prostate cancer: a retrospective, bicentric, descriptive study

Abstract

There are a lot of criteria characterizing high- risk of progression prostate cancer (PCa) nowadays. Radical prostatectomy (RPE) being used for years makes it possible to perform this surgery in patients with locally advanced PCa without the risk of increasing the number of complications. Material and methods. Retrospective, descriptive, bicentric study, made on a total number of 276 patients (91 – locally advanced PCa, and 185 – local PCa). The evolution of 36 months of follow-up was described. Results. Radical prostatectomy provided reliable control of the tumor in 75% of patients with locally advanced PCa, allowed to assess more accurately the extent of the tumor process. Biochemical progression was significantly more frequently found in patients with pT3 stage of PCa; however, only in 5.6% of them, postoperative levels of PSA were over 0.2 mg/mL. Only 32.5% of these patients required multimodal treatment within the first 12 months of postoperative follow- up. Out of them, 18.9% required adjuvant radio therapy (RT), 3.2% – adjuvant hormonal therapy (HT) and 13.1% – RT and HT taking in consideration negative prognostic factors. Conclusions. Radical prostatectomy offers a reliable control of tumours in the majority of patients with locally advanced prostate cancer and allows better evaluation of the extension of the neoplastic process. Patients with pT3 stage of cancer need a more rigorous control of PSA levels in the first 12 months after the surgery, in order to early initiate other adjuvant therapies. It is also reasonable to initiate a protocol of programmed control of patients that underwent radical prostatectomy in the first 24 months after the surgery, in order to early identify tumour progression from pre-existent micrometastasis in retroperitoneal lymphatic nodes and bones that are undetectable preoperatively.