High risk localized and locally advanced prostate cancer: Long-term oncological outcomes after prostatectomy

Introduction. - High risk localized and locally advanced forms are responsible for the vast majo-rity of specific deaths from prostate cancer among non-metastatic diseases at diagnosis. No randomized study has yet been published to establish the best local treatment in terms of survival.Aim. - Conduct a large-volume cohort study with long-term follow-up to analyze specific and overall survival outcomes after surgery. Method. - A single-center retrospective study of all patients operated on for localized high-risk and locally advanced prostate cancer was performed. Actuarial survival analyses and multiva-riate analyses were performed to discern predictive risk factors.Results. - Five hundred patients were included. MRI stage was >= iT3a in 40.7% of cases and 50.2% of patients had a Gleason score >= 8 on biopsy. The mean follow-up was 63.1 months. The overall, specific and biological recurrence-free survival were respectively 77.6%, 93.9% and 26.8% at 10 years. A PSA level >= 20, a Gleason score on biopsy >= 9 and a MRI stage >= iT3a were significantly associated with the 10-years biological recurrence risk.Conclusion. - This study shows very good long-term oncological results. In the absence of a randomized controlled trial, these results suggest the primary role of surgery in this indication and support the evolution of current practices. We pointed out very pejorative features that might help selection of the best candidates for surgical treatment. Level of evidence. - 4.(c) 2022 Published by Elsevier Masson SAS.