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Radical prostatectomy for cT3–4 disease: an evaluation of the pathological outcomes and patterns of care for adjuvant radiation in a national cohort
Author(s) -
Schreiber David,
Rineer Justin,
Sura Sonal,
Teper Ervin,
Nabhani Tom,
Han Peter,
Schwartz David,
Choi Kwang,
Rotman Marvin
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09875.x
Subject(s) - prostatectomy , medicine , cohort , pathological , prostate cancer , radiation therapy , prostate specific antigen , logistic regression , disease , cohort study , population , oncology , cancer , urology , environmental health
Study Type – Therapy (cohort) Level of Evidence 2b OBJECTIVE• To use the Surveillance, Epidemiology and End Results Database to evaluate the pathological outcomes for patients with clinically staged T3–4 disease who undergo radical prostatectomy and to analyze whether these patients are receiving adjuvant radiation.PATIENTS AND METHODS• We identified patients who were clinically staged as having T3–4N0M0 prostate cancer and underwent radical prostatectomy between 2004 and 2006. Clinical data regarding preoperative prostate‐specific antigen, as well as pathological Gleason score, were also collected. • Descriptive analyses were performed regarding the pathological extent of disease for these patients. • Logistic regression analysis was performed to identify unadjusted and adjusted predictors of radiation use for those with non‐organ‐confined disease or positive margins.RESULTS• A total of 718 patients were identified. Of these, 10.2% had organ‐confined disease (8.1% with negative margins and 2.1% with positive margins). The median number of lymph nodes removed was three, with 9.9% of patients having pathologically positive lymph nodes. • The clinical accuracy of staging was found to be 81.4% for T3a, 77.4% for T3b and 70.1% for T4. Of those who had non‐organ‐confined disease or positive margins pathologically, 21.1% received adjuvant radiation. Logistic regression analysis revealed that those with Gleason 8–10 disease were most likely to receive adjuvant radiation.CONCLUSIONS• In this large series from a population‐based cohort, clinical staging of T3–T4 disease was highly accurate in predicting pathological extent, with only 10.2% of patients found to have pathological T2 disease. • Most patients with confirmed pathological T3–T4 disease did not receive adjuvant radiation.