Login to Access Video or Poster Abstract: MP47-08
Sources of Funding: None

Introduction

With improved surgical technique and understanding of the disease, radical prostatectomy (RP) is increasingly offered for locally advanced prostate cancer. RP in T3 prostate cancer may be associated with incomplete local tumour control, and functional outcomes may be worse because of the need for wider resection margins. We examined the oncological and functional outcomes in of patients undergoing RP in T2 and T3 prostate cancer.

Methods

A retrospective review was conducted including all patients listed in the SA-PCCOC database who underwent RP with stage pT2a-c or pT3a-b prostate cancer (any PSA, and any biopsy Gleason score). Demographics, PSA values, imaging characteristics, pathological details, intraoperative blood loss and length of stay were recorded. Oncological outcome was assessed by final histology report, margin status, and presence of and time to biochemical recurrence. Functional outcomes were assessed using the EPIC 26 questionnaire (urinary incontinence and erectile dysfunction domains).

Results

1254 patients underwent RP for pT2, and 1297 patients for pT3 prostate cancer. In the patients with pT2 prostate cancer PSA values were <4 in 9.4%, 4-10 in 45.8%, 10-20 in 10.7% and > 20 in 1.4%. The patients with pT3 prostate cancer PSA values were <4 in 5.6%, 4-10 in 37.2%, 10-20 in 14.3% and > 20 in 3.6%. The Gleason scores in patients with pT2 were Gleason 3+3 in 51.9%, 3+4 in 30.3%, 4+3 in 9.4%, 4+4 in 5.2%, 5+4 in 3.2% patients. The Gleason scores in patients with pT3 were Gleason 3+3 in 25.8%, 3+4 in 35.1%, 4+3 in 21.7%, 4+4 in 16.1%, 5+4 in 1.3% patients. No significant difference was observed in blood loss and length of stay between the groups (p=0.85 and 0.83, respectively). Nerve sparing surgery was more frequently performed in patients with pT2 disease compared with pT3 (85.7% vs 75.8%, p<0.001). Despite this, the erectile dysfunction and urinary continence rates were comparable in the two groups. pT3 patients were at higher risk of biochemical recurrence (BCR) than pT2 patients (HR 1.96, 95% CI 1.6-2.5, p<0.001). Factors influencing biochemical recurrence were PSA >20 at presentation (HR 1.9, 95% CI 1.7-5.3, p<0.001), positive margin (HR 2.9, 95% CI 2.4-3.5, p<0.001), high Gleason scores- Gleason 4+3 (HR 4.2, 95% CI 3.0-5.9, p<0.001) and Gleason >7(HR 5.2, 95% CI 3.6-7.7, p<0.001).

Conclusions

Although T3 patients have an increased risk of BCR than T2 patients, the functional outcomes are comparable. This is despite a difference in the rate of nerve-sparing surgery in the groups.

Funding

None