Tumorcontrole bij patiënten met klinisch niet-gemetastaseerd prostaatcarcinoom, behandeld met radicale prostatectomie: een prospectief onderzoek

To investigate the results regarding progression and survival in patients with clinically non-metastasized prostatic carcinoma treated by radical prostatectomy.

Design

Prospective, descriptive.

Setting

Department of Urology, University Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.

Methods

Data on clinical and biochemical progression of the tumour and on the (prostate cancer-specific) survival were collected regarding 273 patients treated between January 1977 and December 1994 by radical prostatectomy for clinically non-metastasized prostatic carcinoma. Progression and survival after 5, 10 and 15 years were calculated using the Kaplan-Meier method and the Cox proportional hazards model. The prognostic significance for progression and survival of pathological variables in the radical prostatectomy specimina (tumour size, regional lymph node metastases, vascular invasion, perineural invasion, seminal vesicle invasion, positive lateral resection margins, positive apical resection margins, capsule perforation, degree of malignancy) was determined by univariate and multivariate analysis.

Results

The calculated cumulative proportions for clinical progression after 5, 10, and 15 years were 27, 53 and 63, respectively. For local recurrence these numbers were: 11, 24 and 24, for distant metastases: 21, 41 and 53, for biochemical progression (only determined after 5 years): 52. The overall survival rates after 5, 10, and 15 years were 82, 63 and 55, for cancer-specific survival these numbers were 92, 82 and 82. All pathological variables evaluated were statistically significant prognostic factors; the main ones were: vascular invasion (relative risk (RR): 2.5), capsular perforation (RR: 2.5), poorly differentiated carcinoma (RR: 1.8) and positive lateral resection margins (RR: 1.6).

Conclusion

Radical prostatectomy gave good results as regards progression and survival in patients with clinically non-metastasized prostatic cancer.