JCU - January 2022 - 25

958207
URO
Journal of Clinical UrologyGilliland et al.
Case Series
Surgery for pathological T3a, T3b and
lymph node positive, prostate cancer:
surgical, functional and oncological
outcomes
Niall Gilliland1, Sarath Vennam2, Robert Geraghty1,
Julian Peacock3 , Matthew Crockett4 , Samantha Kearley1,
Jon Oxley1, Tim Porter5, Elizabeth Waine6, Jonathan Aning1,
Edward Rowe1 and Anthony Koupparis1
Abstract
Objective: To investigate and document the surgical, functional and oncological outcomes following surgery for highrisk
prostate cancer patients.
Patients and methods: Patients with pathological T3a, T3b and N1 disease were extracted from our prospectively
updated institutional database. Data include demographics, preoperative cancer parameters, short and long-term
complications and functional results. Details of biochemical recurrence, type and oncological outcome of salvage
treatments, cancer-specific and overall survival were also obtained.
Results: A total of 669 patients were included; 58.9% had T3a disease, 35.9% had pT3b and 11.4% N1 disease. With a
median follow-up of 66 months (8-129), overall survival was 94.3%, cancer-specific survival was 98.7% and biochemical
recurrence was 45.6%. Average inpatient stay was 1 day and the overall complication rate was 9.1%; 54.2% experienced
a biochemical recurrence and 90.3% went on to have one or more salvage treatments, which were varied. Significant
predictors of biochemical recurrence included pathological stage, any positive margin and patient age (P<0.005). A total
of 44.9% had an immediate biochemical recurrence, with 90% receiving subsequent treatment and 20.5% having a durable
response. None of the patients receiving prostate bed radiotherapy alone had a durable response. 54% had a delayed
biochemical recurrence, with 63.5% receiving subsequent treatment and 44% having a durable response.
Conclusions: Surgery is associated with encouraging surgical and functional outcomes, cancer-specific survival and
overall survival rates in these patients. Pathological stage is a significant predictor of biochemical recurrence. The
present analysis shows that long-term observation for certain patients with biochemical recurrence is appropriate and
questions the effectiveness of further local salvage treatments in patients with an immediate biochemical recurrence
postoperatively.
Level of evidence: II
Keywords
Prostate cancer, high risk, surgery, radiotherapy, oncology
Date received: 1 May 2020; accepted: 12 August 2020
1The Bristol Urological Institute, North Bristol NHS Trust, UK
2Department of Urology, Royal Cornwall Hospital, UK
3Department of Urology, Torbay Hospital, UK
4 Department of Urology, Gloucestershire Hospitals NHS Foundation
Trust, UK
5Department of Urology, Yeovil District Hospital, UK
6Department of Urology, Royal Devon and Exeter Hospital, UK
Corresponding author:
Anthony Koupparis, The Bristol Urological Institute, North Bristol
NHS Trust, Southmead Hospital, Southmead Road, Westbury-onTrym,
Bristol BS10 5NB, UK.
Email: anthonykoupparis@googlemail.com
Journal of Clinical Urology
2022, Vol. 15(1) 25 -35
© British Association of
Urological Surgeons 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/2051415820958207
journals.sagepub.com/home/uro
https://doi.org/10.1177/2051415820958207
https://uk.sagepub.com/en-gb/journals-permissions https://www.doi.org/10.1177/2051415820958207 https://journals.sagepub.com/home/uro

JCU - January 2022

Table of Contents for the Digital Edition of JCU - January 2022

Contents
JCU - January 2022 - Cover1
JCU - January 2022 - Contents
JCU - January 2022 - 2
JCU - January 2022 - 3
JCU - January 2022 - 4
JCU - January 2022 - 5
JCU - January 2022 - 6
JCU - January 2022 - 7
JCU - January 2022 - 8
JCU - January 2022 - 9
JCU - January 2022 - 10
JCU - January 2022 - 11
JCU - January 2022 - 12
JCU - January 2022 - 13
JCU - January 2022 - 14
JCU - January 2022 - 15
JCU - January 2022 - 16
JCU - January 2022 - 17
JCU - January 2022 - 18
JCU - January 2022 - 19
JCU - January 2022 - 20
JCU - January 2022 - 21
JCU - January 2022 - 22
JCU - January 2022 - 23
JCU - January 2022 - 24
JCU - January 2022 - 25
JCU - January 2022 - 26
JCU - January 2022 - 27
JCU - January 2022 - 28
JCU - January 2022 - 29
JCU - January 2022 - 30
JCU - January 2022 - 31
JCU - January 2022 - 32
JCU - January 2022 - 33
JCU - January 2022 - 34
JCU - January 2022 - 35
JCU - January 2022 - 36
JCU - January 2022 - 37
JCU - January 2022 - 38
JCU - January 2022 - 39
JCU - January 2022 - 40
JCU - January 2022 - 41
JCU - January 2022 - 42
JCU - January 2022 - 43
JCU - January 2022 - 44
JCU - January 2022 - 45
JCU - January 2022 - 46
JCU - January 2022 - 47
JCU - January 2022 - 48
JCU - January 2022 - 49
JCU - January 2022 - 50
JCU - January 2022 - 51
JCU - January 2022 - 52
JCU - January 2022 - 53
JCU - January 2022 - 54
JCU - January 2022 - 55
JCU - January 2022 - 56
JCU - January 2022 - 57
JCU - January 2022 - 58
JCU - January 2022 - 59
JCU - January 2022 - 60
JCU - January 2022 - 61
JCU - January 2022 - 62
JCU - January 2022 - 63
JCU - January 2022 - 64
JCU - January 2022 - 65
JCU - January 2022 - 66
JCU - January 2022 - 67
JCU - January 2022 - 68
JCU - January 2022 - 69
JCU - January 2022 - 70
JCU - January 2022 - 71
JCU - January 2022 - 72
JCU - January 2022 - 73
JCU - January 2022 - 74
JCU - January 2022 - 75
JCU - January 2022 - 76
JCU - January 2022 - 77
JCU - January 2022 - 78
JCU - January 2022 - Cover3
JCU - January 2022 - Cover4
https://www.nxtbookmedia.com