UroToday - AUA 2008 - Society of Urologic Oncology Meeting - Prostate Cancer II – Management of the Primary Tumor in High Risk Nonmetastatic Prostate Cancer - Argument for an Integrated Approach Starting with Surgery

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Saturday, 17 May 2008

ORLANDO, FL

(UroToday.com) - Dr. Benson argued that surgery offers unsurpassed local

control if respectable. He compared it to lumpectomy in breast cancer. The

concordance of high risk patients by nomograms with surgery was over 90%. In

African-Americans, there was a 2.3 fold more likely to have a greater that 15%

change in their risk of progression. Thus, identification of high risk patients

is critical. The recurrence of disease in the patients does not necessarily

equate with death from disease in the Columbia

database.

The

correlation of PSA recurrence and clinical disease progression are not well

defined. Molecular markers come into play for identifying these patients. The

right operation is the removal of the entire prostate and an extended lymph

node dissection. He reviewed the Messing trial, which did not have PSA as entry

criteria. However, PSA was available in most. Many of the patients had positive

margins in addition to seminal vesicle invasion and positive lymph nodes.

Immediate androgen deprivation therapy resulted in 75% survival in these patients

at 10 years. He adjusted the patient population using the Kattan nomograms and

this resulted in an even further survival benefit. About 20% of the patients

without ADT survived, suggesting the benefit of PLND. The benefit of extended

PLND is being defined, but there is suggestion from Dr. Studor’s group

that a therapeutic benefit may exist.

Adjuvant

docetaxel following surgery was of benefit, but toxicity was significant.

Current Phase III trials include the VA trial randomized to adjuvant docetaxel

or observation, but not ADT. The CALBG90203 randomizes high risk men to surgery

or neoadjuvant docetaxel followed by RP. He concluded that use of surgery

avoids the obligatory use of ADT in some patients.

Presented

by Benson, MD, at the Annual Meeting of the American Urological

Association (AUA) - May 17 - 22, 2008. Orange

County Convention

Center - Orlando,

Florida, USA.