41 Radical prostatectomy in the treatment of clinically localized prostate cancer Mário Reis 1 , Francisco Pina 2 , Macedo Dias 3 , Henrique Barros 4 , Manuel Perez 5 1 Department of Urology, Faculdade de Medicina do Porto, H. S. João, Porto, Portugal, 2 Department of Pathology 3 Department of Epidemiology, Faculdade de Medicina do Porto, H. S. João, Porto, Portugal 4 Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, NJ, USA Correspondência: Mário Reis – Serviço de Urologia, Hospital de S. João – Alameda Hernani Monteiro, 4200-319-PORTO FAX: ++ (351) 22 550 5302 Abstract Objectives : Survival results for 367 radical prostatectomies performed on a caucasian portugueses population of patients in an academic hospital are presented and compared with results obtained in other world-renowned centers of activity. Patients and Methodology : We reviewed the reports of 367 patients treated between 1991 and 2000. All patients had previous histological cancer confirmation by transrectal tru-cut biopsy. The radical prostatectomy was based on the Walsh technique. The clinical evaluation and pathological extent of disease was based on the UICC-TNM (1992 version) classification, and histological grading according to the Gleason method. Patients were divided in groups according to total PSA basal level. Relapse was defined by the biochemical criteria of a PSA greater than 0.2 ng/ml in two successive determinations. Adjuvant radiotherapy was administered to patients with tumors classified as pT3b-c or pN positive and to those with pT3a only if they were deemed to have bad prognostic factors. Results : We found 57.2% patients with organ confined cancer, 38.2% with extraprostatic cancer (pT3), and 4.6 % with metastatic regional lymph node (pN positive). 15% of patients had a Gleason score G2-4, 68.3% G5- 7 and 16.3% G8-10. We observed 7.6% of patients with a PSA range between 0-4 ng/ml, 37.9% between 4.1-10 ng/ml, 36.2% between 10.1-20 ng/ml and 18.3% with more than 20 ng/ml. The overall 5-year biochemical failure- free survival value for our 367 patients was 73.9% (Fig.1) and the values for the pT2, pT3, and pTN+ groups were 78.8 %, 75.2 %, 17.3 %, respectively (p= 0.00025) (Fig. 2). The result by Gleason score G2-4, G5-7, G8-10 was 87.1%, 73.0%, and 55.3%, respectively, (p=0.00016). The results by PSA groups 0-4 ng/ml, 4.1-10ng/ml, 10.1- 20ng/ml and greater than 20 ng/ml were 100%, 78.5 %, 69.6% and 63.7% respectively, (p= 0.00029). Discussion and Conclusions: There was strong evidence that radical prostatectomy favorably alters the survival history of the patient. Prognostic factors allow us to select those with the greatest cure potential, but they are unsufficient to select a curable group with certainty. The results presented in referenced world- renowned hospitals, can be obtained in others hospitals, putting this surgical procedure as a routine one Key Words: prostate cancer, radical prostatectomy, prognostic factors, survival, prostate specific antigen (PSA) Acta Urológica Portuguesa 2001, 18; 1: 41-47 www.apurologia.pt