In this single institution, prospective, non-randomized trial, men were offered primary RP (+/- adjuvant RT) for management of their clinically localized high risk prostate cancer (cT2c, PSA>20, Gleason grade 8-10). 178 men chose to undergo laparoscopic RP with PLND between 2007 and 2016. The utilized ultrasensitive PSA to define PSA recurrence – 2 readings above 0.02 met criteria.
Median follow up was 34 months (range 0.9 – 98 months). Of the entire cohort, 41% went on to receive radiation therapy (adjuvant vs. salvage not defined), and 24.6% went on to receive ADT. On multivariate analysis, only clinical tumor volume was associated with PSA recurrence.
The authors conclude: Young men in particular may have a high chance to avoid ADT (75% in three years) if treated with surgery alone or in combination with radiotherapy. However, with limited follow-up and alternative definition of recurrence, further assessment is required.
Limitations / Discussion / Future Directions:
1. Authors noted and accept the contamination of the study by 19 patients on the RADICALS trial
2. 2 values of uPSA were used as endpoint defining PSA recurrence. However, traditional BCR is defined as 2.0 (or rising PSA after RT). Unclear why the authors used this alternative definition.
3. The authors plan to assess the role for MRI to define tumor volume in the future.
Presenter: P. Servián-Vives
Co-Authors Patel A., Winkler M
Institution: Imperial College Nhs Trust, Dept. of Urology, London, United Kingdom
Written by: Thenappan Chandrasekar, Clinical Fellow, University of Toronto
at the #EAU17 -March 24-28, 2017- London, England