Radical Prostatectomy Outcomes for Locally Advanced, Node-Positive, and Metastatic Prostate Cancer

Radical prostatectomy (RP) for patients with locally advanced, node-positive, and metastatic prostate cancer may be a safe and effective treatment option for advanced disease, according to a study presented at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium.

Surgical management with RP has been considered a conventional option for localized prostate cancer. However, recent research suggests an overall survival benefit of treating the primary tumor with radiation therapy in metastatic disease. While RP may have a role in treating metastatic prostate cancer, the perioperative safety of this option needed further research.

Rishabh Simhal, MD, and colleagues designed a study to compare the perioperative outcomes of RP for locally advanced, node-positive, and metastatic prostate cancer using the National Surgical Quality Improvement Project database. A total of 5248 RPs with pathologic staging data available from 2019 to 2020 were used for the analysis.

After grouping the patients into 6 categories (T1N0M0-T2N0M0, T3N0M0, T4N0M0, T1-3N1M0, T4N1M0, and T1-4N0-1M1), researchers compared baseline age, race, and medical comorbidities. Then, they further grouped the patients: T1-2N0M0 versus T3-4N0M0 to compare the effect of locally advanced disease, N1M0 (any T) versus N0M0 (any T) to compare the effect of node-positivity, and N0M1 (any T) versus N0M0 (any T) to compare the effect of metastases.

Among the measures assessed and compared between the groups were 30-day outcomes, operative time, hospital length of stay, 30-day mortality, readmissions, reoperations, major complications, minor complications, and surgery-specific complications.

Researchers noted that baseline demographics were largely similar among all patients, though there were more Black patients, more cases of diabetes, and increased smoking in the node-positive group and increased age in the T4 group.

Results showed a slightly higher rate of minor complications in the locally advanced (T3-4N0M0) versus localized (T1-2N0M0) group but no significant difference in major complications, 30-day mortality, readmissions, or rectal injuries. When compared with node-negative patients (T1-4N0M0), node-positivity (T1-4N1M0) was associated with longer operative time, hospital length of stay, and incidence of 30-day renal failure but was otherwise not associated with a higher rate of any complication.

Additionally, researchers acknowledged that compared with nonmetastatic cases (T1-4N0M0), metastatic cases (T1-4N0M1) were associated with a higher rate of bleeding, prolonged nasogastric tube use, ureteral obstruction, and hospital length of stay.

“Given the potential survival benefit in treating the primary tumor in advanced disease, there may be a role for RP in treating patients with advanced prostate cancer,” they wrote.