S.A. Vozianov, V.N. Grygorenko, R.O. Danilets, S.N. Shamraev, A.V. Bardin, A.Yu. Gurzhenko, L.V. Pereta

Radical prostatectomy for patients with clinically localized and locally advanced prostate cancer: the remote results of treatement

The purpose of the work was to improve the treatment results among patients with clinically local and locally advanced prostate cancer while using neo-and/or adjuvant hormone- and radio therapy.

Materials and methods. Radical prostatectomy results estimation was conducted among 170 patients. An average survey period continued 35,99±1,88 (1-102) months. An average age was 61,66±0,45 (40-75) years. Moreover, after operation 125 (73,5%) patients proved to have clinically local forms of prostate cancer (рТ1а,b,c,2aN0М0 - 99, рТ2b,cN0М0 - 26), 25 (14,7%) patients - locally advanced forms (рТ3a,bN0М0) and 19 (11,2%) - generalized forms of prostate cancer (рТ4N0М0, рТ2а,bN1М0,). Metastases in pelvic lymph nodes developed among 10 (5,9%) patients.

43 (25,3%) patients with II-III stages received neoadjuvant hormone therapy treatment due to maximum androgen blockade scheme. An average neoadjuvant hormone therapy duration: 10,14±1,98 (1-60) months. The typical characteristic of modified radical prostatectomy is accurate ejection of urinary bladder neck and proximal area of prostatic urethra part from prostate gland. Already formed urethra-urethral anastomosis is additionally fixed to lateral part of endopelvic fascia.

Results. An average 3-year survival made up 95,5±3,5% 5-year - 84,1±4,7% 7-year - 71,7±6,8% respectively. 3 and 5-year relapse-free survival comprised 87,05±3,20% 79,64±3,03% 67,11±3,93% respectively. 5-year survival among patients with localized prostate cancer made up 97,18±3,27%. 48 (28,2%) patients proved to have biochemical relapse so that they were prescribed adjuvant hormone - and/or radiotherapy treatment. Gleason index  7 and initial PSA level 20 ng/ml, and their combination are considered as significant factors that foresee Т > Т2 category and biochemical relapse. For рN+ category initial PSA  20 ng/ml level is principle. Frequency of disease relapse development was proved after post-operation detection of perineural invasion, tumoral fimbria and lymphatic nodes. Existence of biochemical relapse, surgical fimbria, perineural invasion and metastasis was associated with mortality risk. However, such regularity was not proved for positive lymphatic nodes.

Conclusions. Neoadjuvant hormone therapy do not prevent from biochemical relapse after radical prostatectomy. Existent tumour process distribution displacement after operation to the stage augmentation testifies the necessity to negative prognosis patients’ selection in order to prescribe adjuvant hormone treatment and/or radiotherapy, which can have significant positive impact on surgical treatment remote results. Applying the differentiating approach in prostate cancer treatment provides an opportunity to reach the highest level of 5-years survival - 84,1±4,7%.