Treatment management and oncological outcomes of patients with pT3 prostate cancer after robot assisted radical prostatectomy

The incidences of prostate cancer have been increasing with age in parallel with the increases in life expectancy and elderly population(1); and prostate cancer has emerged as a disease of increasing importance for men in the world. The gold standard treatment of prostate cancer is radical prostatectomy for the patients whose life expectancies are more than 10 years. The robot assisted radical prostatectomy(RARP), which has been started to be performed since the early 2000s, has been gaining importance day by day as a minimally invasive alternative approach for this treatment. The pathological T3 prostat cancer means extraprostatic extension an no consensus has been reached on the treatment modality of this disease which includes a more aggressive patient subgroup(2). The aim of this study is to contribute to the literature and treatment algorithms for pT3 prostat cancer which will be developed in the future; because there has been no standard protocol for the management of pT3 prostate cancer. In this retrospective study we evaluated the data of 483 pT3 prostate cancer patients who underwent RARP in our clinic between 2010-2017 and whose pathology results were T3. The exclusion criteria for patients were to get any treatment of radiotherapy, hormonotherapy or chemotherapy before RARP; to get chemotherapy after RARP; to have clinic t1a and t1b disease and to be followed up less than 36 months. Finally 326 patients were included in this study. For these 326 patients postoperative treatment modalities were compared and the oncological outcomes were evaluated. In this study biochemical recurrence was defined as a rise in PSA to 0.2 ng/mL. All patients were followed only with monitoring serum PSA level until biochemical recurrence occurs and after biochemical recurrence, salvage treatment were given to the all patients . The treatment modalities were grouped as the patients who got radiotherapy, hormonotherapy and radiotherapy+hormonotherapy. The statistical analyses were made to find out which features of the patients who were identified with biochemical recurrence cause increases in the biochemical recurrence. 3 and 5 years biochemical recurrence free survival, cancer specific survival and overall survival rates were calculated and compared with the data in the literature. Keywords: pT3 prostate cancer, robot assisted radical prostatectomy, postoperative treatment, oncological outcomes