Disease control

The long-term efficacy of RPP in achieving disease control in patients with clinically organ-confined prostate cancer has been documented in large patient series with extended follow-up.2 We have used the term 'cancer-associated death' to define outcome in terms of survival in this patient population: When a patient dies of any cause with a biologically active malignancy, as witnessed by a rising PSA level ^0.5, survival is considered a function of the underlying tumor biology and the event considered a 'cancer-associated death'. Studies from our institution using these end-points have demonstrated the profound impact of the biology of the tumor on the time to recurrence and long-term survival. They further suggest that many current series of alternative curative therapies may lack follow-up of sufficient duration to permit comparison with the results of radical surgery. While the use of different staging systems and end-points of outcome cloud a direct comparison between RPP and RRP, the disease control achieved by RPP and RRP may be considered equivalent.

Patients with organ-confined disease in the RPP specimen experience long-term survival with 10- and 15-year cancer-associated survival rates of 92.9% and 85.5%, respectively. The median time to cancer-associated death in a series of 1091 patients with pathologically organ-confined disease and a median follow-up of 5 years was not reached (Fig. 33.5). This was true across all Gleason score categories (Gleason sums 2-4, 5-6, 7, 8-10) including patients with high-grade disease (Gleason sum 8-10) (Fig. 33.6). These data suggest that low-volume, high-grade disease may be successfully treated by radical surgery as previously suggested by Ohori etal.18 These findings argue for the potential benefit of prostate cancer screening programs for earlier disease detection.

Patients with specimen-confined and margin-positive disease experienced significantly lower, nevertheless extended long-term survival rates (Table 33.1). The outcome of patients with specimen-confined disease was not as good as that of patients with organ-confined disease, but significantly better that the m e

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