CONTINENCE AND POTENCY RATES FOLLOWING RADICAL PROSTATECTOMY VERSUS RADIATION THERAPY IN MEN WITH T3 PROSTATE CANCER. 10 YEAR FOLLOW UP

Introduction & Objectives: To evaluate oncological and functional outcomes of radical prostatectomy and radiation therapy in men with cT3 prostate cancer and to analyse independent factors allowing an accurate patient selection. Material & Methods: Between 1993 and 2006 a total of 695 patients with cT3 Prostate cancer and PSA < 25ng/ mL were treated either by radiation therapy (n=302) with the MD Anderson scheme (78 Gy and hormone therapy, XRT+HT) or radical prostatectomy with lymphadenectomy (n=393)(RPE). Treatment allocation was strictly selected for each centre to avoid selection bias. Follow up was routinely done at 3 month intervals. Progression free survival and cancer specific survival was calculated for each group and a neural network created to investigate the impact of grade, PSA and age. In addition continence (<1 pad) and potency rates were evaluated. With respect PSA, lower PSA(<4) performed worse than men with intermediate PSA, whereas young men clearly had the worse outcome. When comparing treatment strategies, radiation+HT was equal to RPE in men with GS<7, PSA 4-10 and close to RPE in men older than 60. Otherwise RPE performed better in terms of DSS and CSS. Conclusions: Men with cT3 prostate cancer do represent an inhomogeneous cohort. Men < 60 years, PSA < 4 or PSA >10 and GS >7 show better DSS and CSS with radical prostatectomy versus radiation therapy at 5 and 10 years follow up. Continence and potency results were equal and strongly age dependent.