Extended Experience With Radical Prostatectomy for Clinical Stage T3 Prostate Cancer: Outcome and Contemporary Morbidity

Abstract

Radical prostatectomy for clinical stage T3 prostate cancer has not been widely accepted due to the potential for incomplete excision of the local tumor and high incidence of lymph node metastases. In addition, contemporary morbidity is unknown. We report the long-term results in 812 patients with clinical stage T3 prostate cancer treated with radical prostatectomy. Between 1966 and 1992, 812 patients with clinical stage T3 prostate cancer underwent radical prostatectomy of whom 479 (60 percent) received adjuvant therapy. Mean patient age was 65 years (range 40 to 78). Mean followup was 4.5 years (range up to 24). Disease was stage pT2c or less in 17 percent of patients, pT3a to c in 49 percent and node-positive in 33 percent. Of the primary tumors pathological Gleason score was 7 or greater in 62 percent. Crude and cancer-specific survival rates at 5, 10 and 15 years were 86 percent, 70 percent and 51 percent, and 90 percent, 80 percent and 69 percent, respectively. Operative morbidity paralleled that of patients with clinically localized disease (T2c or less). An excellent survival rate with low treatment related morbidity can be achieved by performing primary radical prostatectomy with adjuvant therapy in the patient with clinical stage T3 prostate cancer.