-Original-

Long-Term Oncological Outcomes for Histologically Confirmed High-Risk Prostate Cancer

Hayato Takeda¹, Jun Akatsuka¹, Endo Yuki¹, Ichiro Matsuzawa¹, Yasutomo Suzuki^1,2, Tsutomu Hamasaki³, Go Kimura¹ and Yukihiro Kondo¹

¹Department of Urology, Nippon Medical School, Tokyo, Japan
²Department of Urology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
³Department of Urology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan

Background: The optimal treatment modality for locally advanced prostate cancer has not been established. Radiotherapy, hormonal therapy, and combination treatments are the main strategies, although the feasibility of radical prostatectomy as a first-line therapy needs to be considered. This retrospective analysis of pathological results of extracted specimens evaluated long-term oncological outcomes for high-risk prostate cancer treated surgically. The association of number of risk factors with long-term outcome was specifically analyzed.
Methods: We identified patients with high-risk prostate cancer who underwent laparoscopic radical prostatectomy, without neoadjuvant therapy, at Nippon Medical School from 2000 to 2012. Risk factors were a prostate-specific antigen (PSA) concentration ≥20 ng/mL, pathological ≥T3, and pathological Gleason Score ≥8. Biological failure was defined as a PSA concentration ≥0.2 ng/mL.
Results: 222 men were identified. One patient had a positive lymph node status, and there was a significant difference in surgical margin positivity (52 men, 68.4% vs 56 men 38.4%) between patients with and without biochemical failure. Among patients meeting the high-risk criteria with a follow-up of up to 133 months, the biochemical recurrence (BCR)-free survival rates at 5 and 10 years were 62.8% and 58.4%, respectively, and mean time to BCR was 14.0 months. BCR-free survival rates at 5 and 10 years were 73.6% and 71.4%, respectively, for 1 risk factor, 48.7% and 34.6% for 2 factors, and 34.5% and 34.5% for 3 factors. Patients with a single risk factor had a significantly better outcome than those with multiple risk factors. The overall survival rates at 5 and 10 years were 94.6% and 93.7%, and the cancer-specific survival rate was 100% at both 5 and 10 years.
Conclusions: Reasonable long-term oncological outcomes can be achieved by surgical treatment for high-risk prostate cancer. Patients with 1 risk factor had a significantly better BCR-free rate than those with multiple risk factors.

J Nippon Med Sch 2023; 90: 202-209

Keywords
prostate cancer, high risk, prostatectomy

Correspondence to
Yukihiro Kondo, Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
kondoy@nms.ac.jp

Received, July 1, 2021
Accepted, December 28, 2022