Long-term outcome following radical prostatectomy for Gleason 8-10 prostatic adenocarcinoma.

PURPOSE: Compared to low-grade disease, high-grade prostate cancers exhibit a higher rate of disease progression. As a result, there has been a trend to treat high-risk disease with methods other than surgery. The purpose of this study is to evaluate the long-term survival following radical prostatectomy (RRP) for non-metastatic Gleason 8-10 prostate adenocarcinoma (CaP). METHODS: All patients 75 years or less with Gleason 8-10 CaP that underwent RRP were identified from the SEER 18 database. Patients with metastatic disease, those who underwent other modalities of treatment, or with more than one primary cancer, were excluded. Data were analyzed for demographics, stage at presentation, treatment modality, and overall survival and cancer-specific survival. RESULTS: A total of 30,379 men met inclusion criteria. Mean age was 62.5 years and 82.5 % of patients were white. A total of 52.8 % of patients had T2 disease, and 73.1 % had node-negative disease, 80.2 % of patients underwent pelvic lymph node dissection, and 12.9 % underwent adjuvant radiation therapy. Overall survival for the entire cohort was 92.8, 78.6, 59.5, 38.6, and 20.0 % for 5, 10, 15, 20, and 25 years, respectively. Cancer-specific survival was 96.4, 89.5, 82.0, 72.9, and 68.8 % for 5, 10, 15, 20, and 25 years, respectively. CONCLUSIONS: Although historically underutilized in patients with poorly differentiated disease, radical prostatectomy provides excellent long-term survival and should be offered to healthy patients.

Comparative survival following different treatment modalities for stage T2 bladder cancer in octogenarians.

PURPOSE: A higher rate of comorbidities and an anticipated higher operative risk in octogenarians may influence urologists in opting for less aggressive and less effective treatment modalities for muscle-invasive bladder cancer. This study was performed to compare survival after different treatment modalities in octogenarians with stage T2 bladder cancer. METHODS: Patients that were 80 years or older with a diagnosis of transitional cell carcinoma of the bladder were identified using the Surveillance, Epidemiology, and End Results-17 registry database between 1988 and 2007. Patients were analyzed for treatment method and outcomes, including overall survival (OS) and cancer-specific survival (CSS). RESULTS: A total of 3,232 patients met inclusion criteria. Of these, 69 % (N = 2,216) underwent only transurethral resection (TURBT), 23 % (N = 733) underwent pelvic radiation therapy (RT), and 9 % (N = 283) underwent definitive surgical therapy. The 3-, 5-, and 10-year OS rates were 22.2, 15.0, and 4.4 %, respectively, for TURBT; 27.8, 18.3, and 3.5 % for RT; and 52.7, 39.1, and 17.2 % for definitive surgery. The 3-, 5-, and 10-year CSS rates were 38.3, 33.4, and 27.4 %, respectively, for TURBT; 41.6, 35.0, and 27.2 % for RT; and 66.6, 55.5, and 49.9 % for definitive surgery. Both partial and radical cystectomy had significantly longer CSS rates at 3 and 5 years when compared to RT (p ≤ 0.001). CONCLUSIONS: Compared to other treatment modalities, surgery, either radical cystectomy or partial cystectomy, offers the best OS and CSS for men aged 80 years or older with T2 bladder cancer.