T3 prostate Ca patients appear to be better off with surgery than radiation

Patients with clinical T3 (cT3) disease are often better off having surgery than going directly to a radiation oncologist, according to a new study.

The typical cT3 prostate cancer patient's survival rate is about 79% at 15 years for those who undergo radical prostatectomy, about the same rate as it is at 5 years after radiation therapy without surgery, according to senior study investigator Horst Zincke, MD, PhD, urologist and director of uro-oncologic surgery at the Mayo Clinic, Rochester, MN.

Researchers used a cancer registry to identify 5,662 men who had RP with pelvic lymph node dissection between 1987 and 1997 (the period since the advent of PSA testing). They plotted and compared cancer-specific, overall, and disease-free survival of patients having RP for clinically advanced cT3 prostate cancer with those of patients having surgery for cT2 disease during the same period.

With more than 10 years median follow-up, Dr. Zincke and colleagues reported that freedom from local or systemic disease at 5 years after RP for cT3 disease was 85%; it was 73% after 10 years and 67% at 15 years. Respective cancer-specific survival rates were 95% at 5 years, 90% at 10 years, and 79% at 15 years.

Interestingly, they found that 27% of the men who did not receive neoadjuvant therapy were clinically over-staged and actually had confined cancer on pathologic examination (pT2).

Complication and incontinence rates were similar after RP for cT2 and cT3 patients.