ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2019 October;71(5):508-15

DOI: 10.23736/S0393-2249.19.03388-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Multimodal treatment for high-risk locally-advanced prostate cancer following radical prostatectomy and extended lymphadenectomy

Fabio ZATTONI ¹ ✉, Alessandro MORLACCO ^{1, 2}, Fabio MATRONE ³, Mauro ARCICASA ³, Lorenzo BUTTAZZI ⁴, Daniele MARUZZI ⁴, Lucia FRATINO ⁵, Giovanni LO RE ⁵, Roberto BORTOLUS ³

¹ Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy; ² Department of Oncological and Surgical Sciences, Clinic of Urology, University of Padua, Padua, Italy; ³ Department of Radiotherapy, National Cancer Institute (CRO), Aviano, Pordenone, Italy; ⁴ Department of Urology, General Hospital of Pordenone, Pordenone, Italy; ⁵ Department of Medical Oncology, National Cancer Institute (CRO), Aviano, Pordenone, Italy

BACKGROUND: The aim of this study was to prospectively evaluate the safety and oncologic outcomes of multimodal treatment in high risk-locally advanced prostate cancer patients (PCa).
METHODS: High-risk-locally advanced prostate cancer patients without distant metastases before radical prostatectomy (RP) were included. Adjuvant high-dose intensity-modulated radiation therapy (IMRT) with concurrent docetaxel and long-term androgen-deprivation therapy (ADT) were started after 3-6 months from RP. ADT was maintained for two years. Acute and late toxicity were evaluated with the Common Terminology Criteria for Adverse Events (v. 3.0). Biochemical and clinical recurrence-free survival were explored by using the Kaplan-Meier method.
RESULTS: Overall 42 patients were included. Acute genitourinary toxicity was observed with Grade I, II, and III in four (9.5%), two (4.8%), and one (2.3%) patients, respectively. Acute gastrointestinal toxicity was reported to be of Grade I and II in 12 (29.3%) and three (7.2%) patients, respectively. In these patients, concomitant genito-urinary and gastrointestinal toxicity occurred in three (7.2%) cases. A residual GU Grade I toxicity was present only in one patient. Toxicity due to CHT was found in four (9.5%) patients. Complete continence after RP and IMRT was achieved in 32 patients (76.2%). After a median follow-up of 3.4 years, BCR and clinical recurrence were observed in 16.7% and 9.5% of patients, respectively. A 5-year biochemical and clinical recurrence-free survival rate were 70.7% and 84.0%, respectively. Five-year overall survival was 93.6%. None of the patients died for prostate cancer during follow-up.
CONCLUSIONS: This novel multimodal treatment paradigm for high-risk locally advanced prostate cancer has an acceptable level of toxicity and good oncological outcomes observed after a long follow-up.

KEY WORDS: Prostatic neoplasms; Prostatectomy; Radiotherapy; Drug therapy; Combined modality therapy