Outcome predictors of radical cystectomy in patients with cT4 prostate cancer: a multi‐institutional study of 62 patients

• Published in: BJU international 2017-11, Vol.120 (5B), p.E52-E58
• Main Authors: Spahn, Martin, Morlacco, Alessandro, Boxler, Silvan, Joniau, Steven, Briganti, Alberto, Montorsi, Francesco, Gontero, Paolo, Bader, Pia, Frohneberg, Detlef, Poppel, Hein, Karnes, Robert Jeffrey
• Format: Article
• Language: English
• Subjects: Aged; Cystectomy; Disease Progression; Disease-Free Survival; Follow-Up Studies; high‐risk prostate cancer; Humans; locally advanced prostate cancer; Lymph Node Excision; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Metastases; Metastasis; Middle Aged; multimodality treatment; Neoplasm Recurrence, Local - pathology; PCSM; Pelvis; Prognosis; Prostate - diagnostic imaging; Prostate - pathology; Prostate cancer; Prostate-Specific Antigen; ProstateCancer; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Prostatic Neoplasms - therapy; Seminal vesicle; Seminal Vesicles - diagnostic imaging; Seminal Vesicles - pathology; Statistical analysis; surgery; Survival; Urinary bladder; Urinary Bladder Neoplasms - secondary; Urinary Bladder Neoplasms - surgery; Urinary Bladder Neoplasms - therapy; uroonc
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.13818

Objectives To identify which patients with macroscopic bladder‐infiltrating T4 prostate cancer (PCa) might have favourable outcomes when treated with radical cystectomy (RC). Materials and Methods We evaluated 62 patients with cT4cN0–1 cM0 PCa treated with RC and pelvic lymph node dissection between 1972 and 2011. In addition to descriptive statistics, the Kaplan–Meier method and log‐rank tests were used to depict survival rates. Univariate and multivariate Cox regression analysis tested the association between predictors and progression‐free, PCa‐specific and overall survival. Results Of the 62 patients, 19 (30.6%) did not have clinical progression during follow‐up, two (3.2%) had local recurrence, and 32 (51.6%) had haematogenous and nine (14.5%) combined pelvic and distant metastasis. Forty patients (64.5%) died, 34 (54.8%) from PCa and six (9.7%) from other causes. The median (range) survival time of the 19 patients who were metastasis‐free at last follow‐up was 86 (1–314) months, 8/19 patients had a follow‐up of >5 years, and five patients survived metastasis‐free for >15 years. Patients without seminal vesicle invasion (SVI) had the best outcomes, with an estimated 10‐year PCa‐specific survival of 75% compared with 24% for patients with SVI. Conclusion For cT4 PCa RC can be an appropriate treatment for local control and part of a multimodality‐treatment approach. Although recurrences are probable, these do not necessarily translate into cancer‐specific death. Men without SVI had a 75% 10‐year PCa‐specific survival. Although outcomes for patients with SVI are not as favourable, there can be good local control; however, these patients are at higher risk of progression and may need more aggressive systemic treatment.