Abstract: PD10-03
Sources of Funding: none

Introduction

Patients with high-risk prostate cancer (PCa) according to D&[prime]Amico risk categories are prone to a pathological diagnosis of positive margins or lymph node invasion and biochemical recurrence, despite having undergone radical prostatectomy (RP).

Methods

84 high-risk PCa patients prospectively underwent &[prime]extended&[prime] RP following neoadjuvant chemohormonal therapy (NCH); primarily 6 months of estramustine phosphate 280 mg bid, along with a LH-RH agonist/antagonist. Our surgical technique was developed to reduce the rates of positive surgical margins. The goal is to approach the muscle layer of the rectum by dissecting the mesorectal fascia and continuing the dissection through the mesorectum until the muscle layer of the rectum is exposed. The procedure was safely performed as a result of good recognition of the structure between the perineal body and the rectal surface. We also performed extended lymphadenectomy if the patients meet two or more of D&[prime]Amico risk categories

Results

Pathological analysis revealed that positive surgical margins were found in only two patients. More than 1 year had elapsed after surgery in 64 of the 84 patients with the median follow-up period of 36.1 months. Among those 64 patients, 12 (18.8%) experienced PSA recurrence (Table 1). Kaplan-Meier analyses revealed that significant poorer PSA progression-free survival were observed in patients with younger age, higher positive biopsy core ratio, positive extra-prostate extension (EPE), lymph node metastasis, and higher pathological stage (pT3a/b). Multivariate Cox-regression analysis revealed that higher pathological stage (pT3a/b) was the only independent valuable for predicting PSA progression failure (Table 2). These 12 cases received salvage androgen deprivation therapy followed-by external beam radiotherapy and showed no progression after the salvage therapies (median follow-up period, 22.9 months after PSA progression).

Conclusions

NCH concordant with extended RP is feasible and contributes to negative surgical margins that might provide good cancer control for patients with high-risk PCa.

Funding

none