Long-term outcome of radical prostatectomy in an observation period of at least 10 years

Purpose: To evaluate the long-term outcome of radical prostatectomy in unselected patients with prostate cancer of relatively poor prognosis. Materials and Methods: Between 1977 and 1989, 293 patients underwent radical retropubic prostatectomy. We analyzed 224 patients with a minimum follow-up of 10 years (mean 14 years, range 10.5 to 24 years). Results: The pathological stage distribution of these 224 patients was pT1 in 14.3 %, pT2 43.6%, pT3 39.1% and pT4 3%. Of these patients, 50 (22.3%) had positive lymph nodes and 45 (20.1%) positive margins. At 10 years after surgery, the actuarial survival rate for all patients was 67.1% and the cancer-specific survival rate 85%. Once progression of the disease developed, the median actuarial time to death was 5.5 years. Since PSA measurements were not introduced in the follow-up after radical prostatectomy until 1986, PSA data were available in only 84 (37.5%) patients. In a survival analysis, preoperative PSA (< 10 mg/ml vs. >= 10 ng/ml) was a significant predictor of the probability of positive margins (22% vs. 78%) and cancer-specific survival (87% vs. 69%) after 10 years. Conclusions: Long-term survival can be expected even in patients with locally advanced prostate cancer treated with radical prostatectomy.