Long-Term Radical Prostatectomy Outcomes Better for cT1a Prostate Cancer
Patients with cT1a and cT1b prostate tumors have favorable long-term outcomes after radical prostatectomy.
SAN DIEGO—Patients with cT1a and cT1b prostate tumors have favorable long-term outcomes after radical prostatectomy (RP), but a small proportion of patients with cT1b cancers will experience systemic progression and die from their cancer, investigators reported at the American Urological Association 2016 annual meeting.
Daniel Moreira, MD, and colleagues at Mayo Clinic in Rochester, MN, retrospectively studied 252 men undergoing RP for localized cT1a and cT1b prostate tumors from 1987 to 2008. The group included 86 men (34%) with cT1a and 166 (66%) with cT1b cancer. Twelve (14%) patients with cT1a disease and 45 (27%) with cT1b disease experienced disease recurrence during a median follow-up period of 14.8 years. Metastatic disease developed in none of the men with cT1a cancer and 9 (5%) of those with cT1b cancer. None of the cT1a patients died compared with 6 (4%) of the cT1b group.
Compared with men cT1b tumors, those with cT1a tumors had significantly longer recurrence-free and metastasis-free survival, and a non-significant trend toward better disease-specific survival.
Positive surgical margins occurred in a significantly smaller proportion of the cT1a than cT1b group (6% vs 24%). A significantly smaller proportion of the cT1a group also had lower pathologic Gleason scores: 95% of the cT1a group had Gleason 2–6 tumors compared with 76% of the cT1b patients. The groups did not differ significantly with regard to preoperative PSA level, pathologic tumor volume, extracapsular extension, seminal vesicle invasion, or lymph node involvement, according to the researchers.
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The researchers noted that the classical decision algorithm is to follow cT1a tumors and treat T1b tumors, but this approach is based on limited studies evaluating biochemical recurrence in small historical cohorts. Dr Moreira's team concluded that their findings support active treatment for selected patients with cT1b cancers.