LONG-TERM RADICAL PROSTATECTOMY ONCOLOGIC OUTCOMES IN PATIENTS WITH CLINICALLY LOCALLY ADVANCED PROSTATE CANCER: A SINGLE-CENTER STUDY.

Background: Prostate cancer (PCa) is the second most frequently diagnosed cancer in males worldwide and placed fifth in cancer mortality among males. Between 14-24% of PCa patients have newly diagnosed advanced stages, which paradoxically has remained stable over time. Aim: To estimate and compare long-term radical prostatectomy (RP) oncologic outcomes in patients with clinically locally advanced prostate cancer (LAPCa), to determine the prognostic significance of common clinical-pathological parameters. Patients and Methods: The study included 105 patients with LAPCa who underwent RP with extended pelvic lymphadenectomy between September 2003 - April 2015. Kaplan - Meier method was used for calculating biochemical recurrence- (BRFS), progression-free- (PFS), overall (OS), and prostate cancer-specific survival (PCSS) rates. Analyses of features associated with outcomes were conducted using Cox proportional hazards regression model. Results: Patients from cT3b group had worse PFS, OS and PCSS rates in comparison with cT3a, while there was no significant difference in BRFS rates. Preoperative serum prostate-specific antigen level (hazard ratio (HR) 1.023, 95% confidence interval (CI): 1.014-1.033, p < 0.001), pT3a (HR 3,027, 95% CI: 1.449-7.096, p < 0.01), pT3b (HR 2.792, 95% CI: 1.133-6.881, p < 0.05) pT4 stage (HR 31.12, 95% CI: 7.646-126.6 p < 0.001) and positive lymph nodes status (HR 6.503, 95% CI: 3.190-13.25, p < 0.001) were significant factors in BRFS. Preoperative serum prostate-specific antigen level (HR 1.018, 95% CI: 1.007-1.030, p = 0.001) and positive lymph nodes status (HR 3.191, 95% CI: 1.672-6.088, p < 0.001) were significant factors in PFS and PCSS. Conclusions: RP as the initial treatment option of multimodal therapy in the management of LAPCa patients demonstrates encouraging oncologic outcomes. Patients from the cT3b group had the worse rates of PFS, OS, and PCSS in comparison with the cT3a group. Heterogeneity of LAPCa patients' outcomes reflects the insufficiency of the existing clinical risk classification for the prediction of systemic progression and cancer-specific survival.