Intermediate-Term Outcome with Radical Prostatectomy for Localized Prostate Cancer: The Cleveland Clinic Experience

Purpose: We examined the results after radical prostatectomy (RP) for clinically localized prostate cancer to determine the 5- and 8-year disease-specific and biochemical relapse-free survival (bRFS), and the clinical and pathologic variables that predict biochemical failure. Materials and Methods: Nine hundred six patients underwent RP for clinically localized prostate cancer between 1990 and 1999. No patient received neoadjuvant or adjuvant therapy. The mean age was 61.9 years (range 40–77 years). The mean preoperative prostate specific antigen (PSA) level was 8.7 ng/ml (range 0.3–54.0). Seventy-six percent of patients had a biopsy Gleason score ≤6, and 49% had disease at clinical Stage T1c. Eighteen percent of patients reported a family history of prostate cancer. Actuarial bRFS rates were calculated using Kaplan-Meier analysis. Results: Pathologic analysis showed that 43% of patients had extracapsular extension, 44% had pathologic Gleason scores ≤6, 23% had positive margins, 8.9% had seminal vesicle invasion, and 1.9% had lymph node metastases. At a mean follow-up of 44 months (range 1–114), the 5- and 8-year cancer-specific survival rates were 97% and 95%, respectively. The actuarial 5- and 8-year bRFS rates were 81% and 76%, respectively. Patients with organ-confined disease had a 100% cancer-specific survival rate and a 92% bRFS rate at both 5 and 8 years. On multivariate analysis, a positive family history (p = 0.019), clinical stage (p = 0.014), preoperative PSA level (p < 0.001), pathologic Gleason score (p < 0.001), extracapsular extension (p = 0.03), positive margins (p < 0.0001), and seminal vesicle invasion (p = 0.0003) were all independent predictors of bRFS. Conclusion: Radical prostatectomy for patients with localized prostate cancer has a high rate of cure for appropriately selected patients.