A. Volpe

B. Frea

C. Terrone

E. De Lorenzis

F. Varvello

G. Marchioro

G. Maso

M. Vidali

M. Zacchero

R. Tarabuzzi

S. Zaramella

English

AIR Universita degli studi di Milano

Group A, 3 patients experienced grade 0-2 rectal toxicity
(diarrhoea and tenesmus), while 4 patients in Group B
experienced these symptoms. For both groups, grade 2 urinary
toxicity occurred in one patient. No significant differences
have been observed for complications or recovery of urinary
continence.
Conclusion: IORT during RP is a feasible and safe
procedure, with a similar complication rate compared to RP
and ART. Therefore IORT can be proposed as a treatment
choice for patients with locally advanced PCa. Longer follow-
up is needed to assess long-term toxicity and local tumour
control with IORT. 
Table I.
Group a (N: 45) Group B (N: 50) p-Value
Neoadjuvant therapy 6/45 (13%) 6/50 (12%) ns
Mean age (years) 67.4 (56-75) 66.8 (48-75) ns
Clinical stage 3T1c–1T2b–2T2c– 3T2a–6T2b–5T2c– ns
19T3a–20T3b 25T3a–7T3b
Mean PSA 27.26 ng/ml 27,5 ng/ml ns
at diagnosis (2.03-63.9) (6.9-169)
Bioptic GS 7.73 (4-9) 7.8 (5-9) ns
Mean operative time 237 185 <0.0001
(min)
Mean hospital stay 4.5 4.5 ns
(days)
pT2 3pT2a–3pT2b– 2pT2b– <0.0001
9pT2c
pT3a 5/45 21/50 <0.0001
pT3b 20/45 19/50 ns
pT4 5/45 8/50 ns
Mean GS 8.1 (6-10) 7.64 (5-10) ns
Positive margins 26/45 (57 %) 30/50 (60%) ns
Anastomosis structure 4/45 (8%) 8/50 (16%) <0.0001
References
1 Orecchia R, Jereczek-Fossa BA, De Corbelli O et al:
Intraoperative radiotherapy for locally advanced prostate
cancer: Treatment technique and ultrasound-based analysis
of dose distribution. Anticancer Res 27: 3471-3476, 2007.
2 Krengli M, Terrone C, Ballarè A et al: Intraoperative
radiotherapy during radical prostatectomy for locally
advanced prostate cancer: Technical and dosimetric aspects.
Int J Radiat Oncol Biol Phys Jul 20, 2009. 
3 Rocco B, Jereczek-Fossa BA, Matei DV, Verweij F, Santoro
L, Vavassori A, Ospina JC, Cedeira F, Ciocca M, Orecchia
R and de Cobelli O: Intraoperative radiotherapy during
radical prostatectomy for intermediate-risk to locally
advanced prostate cancer: Treatment technique and
evaluation of perioperative and functional outcome vs.
standard radical prostatectomy, in a matched-pair analysis.
BJU Int 104(11): 1624-1630, 2009. 
107
RADICAL PROSTATECTOMY FOR PATIENTS
WITH CLINICALLY LOCALLY ADVANCED
PROSTATE CANCER: SURVIVAL ANALYSIS AND
ONCOLOGICAL OUTCOME
Giansilvio Marchioro1, Alessandro Volpe1, Matteo
Vidali2, Gloria Maso1, Stefano Zaramella1 Roberto
Tarabuzzi1, Francesco Varvello1, Monica Zacchero1, 
Elisa De Lorenzis1, Bruno Frea3 and Carlo Terrone1
1Department of Urology, Maggiore della Carità Hospital,
University of Eastern Piedmont, Novara, Italy; 
2Clinical Chemistry Unit, University of Eastern
Piedmont, Novara, Italy; 
3Department of Urology, Santa Maria della Misericordia
Hospital, University of Udine, Udine, Italy
Aim: To report the outcomes of a single institutional study
on 98 patients with clinically locally advanced prostate
cancer (Pca) and prostate-specific antigen (PSA) ≥20
ng/ml who underwent radical prostatectomy (RP) and
pelvic lymphadenectomy (PNLD).
Patients and Methods: We performed a retrospective
review of PCa patients who had initial PSA values above
20 ng/ml and were treated with RP between 1999 and
2005. Biochemical recurrence was defined as a double rise
in PSA levels over 0.2 ng/ml after RP. Adjuvant or salvage
radiotherapy (RT) or hormonal therapy (HT) were
indicated according to institutional protocols. Overall
(OS), cancer-specific (CSS), clinical progression-free
(CPFS), and biochemical progression-free survival (BRFS)
were calculated for the entire cohort and select subgroups
using the Kaplan-Meier method with log-rank test and Cox
multivariate analysis. 
Results: The mean patient age was 66 (range IQR 61,8-
71) years. Mean PSA was 30.4 (range IQR 24.4-45) ng/ml.
PCa was clinically locally advanced in 59% of cases. At
pathology, locally advanced disease was found in 72.4% of
cases (27.6% pT3a, 30.6% pT3b, and 14.3% pT4). Positive
surgical margins and lymph node involvement were
observed in 68% and 23% of cases respectively. Mean
follow-up was 65.3 (range IQR 46.0-96.5) months.
Adjuvant RT and HT were administered in 51% and 69%
of patients. OS, CSS and BRFS at 5 and 10 years were
85% (55%), 93% (71%) and 53% (36%), respectively. We
did not find any significant predictor for OS, CSS and
CPFS. Gleason score at biopsy, but not PSA, was strongly
associated with a worse CSS. Interestingly, we observed
that only pathological stage, seminal vesicle invasion and
PSA at diagnosis were independent predictors of BRFS. 
Conclusion: RP is an effective first step in a
multimodality approach for locally advanced PCa, with
ANTICANCER RESEARCH 30: 1375-1544 (2010)
1434
convincing cancer-related outcomes. Patients with PSA
≥20 ng/ml should be considered for an aggressive
approach, starting with radical surgery. Most patients need
adjuvant HT or RT. This study confirms that RP should be
considered as the first step in a multimodality approach for
clinically locally advanced PCa.
References
1 Van Poppel H and Joniau S: An analysis of radical
prostatectomy in advanced stage and high-grade prostate
cancer. Eur Urol 53: 253-259, 2008.
2 Gontero P, Marchioro G, Frea B et al: Is radical
prostatectomy feasible in all cases of locally advanced
non-bone metastatic prostate cancer? Results of a single-
institution study. Eur Urol 51: 922-930, 2007.
3 Hsu CY, Wildhagen MF, Van Poppel H and Bangma CH:
Prognostic factors for and outcome of locally advanced
prostate cancer after radical prostatectomy. BJU Int Nov
12, 2009.
108
DO PATIENTS TREATED WITH RADICAL
PROSTATECTOMY FOR LOCALLY ADVANCED
PROSTATE CANCER AND PSA >50 ng/ml HAVE A
WORSE PROGNOSIS THAN PATIENTS WITH
PSA>20 ng/ml?
Giansilvio Marchioro1, Gloria Maso1, Matteo Vidali2,
Alessandro Volpe1, Roberto Tarabuzzi1, 
Stefano Zaramella1, Monica Zacchero1, Elisa De
Lorenzis1, Simone Crivellaro3, Bruno Frea3 and 
Carlo Terrone1
1Department of Urology, Maggiore della Carità Hospital,
University of Eastern Piedmont, Novara, Italy; 
2Clinical Chemistry Unit, University of Eastern
Piedmont, Novara, Italy; 
3Department of Urology, Santa Maria della Misericordia
Hospital, University of Udine, Udine, Italy
Aim: To report the outcomes of a single institutional study
on 98 pts with clinically locally advanced prostate cancer
(PCa) and prostate-specific antigen (PSA) ≥20 ng/ml who
underwent radical prostatectomy (RP) and pelvic
lymphadenectomy (PNLD).
Patients and Methods: We performed a retrospective
review of PCa patients who had initial PSA values above
20 ng/ml (Group A), treated with RP between 1999 and
2005. Overall (OS), cancer specific (CSS), clinical
progression free (CPFS), and biochemical recurrence free
survival (BRFS) of these patients were compared with
those of other patients who had initial PSA values above
50 ng/ml (Group B). Biochemical recurrence was defined
as a double rise in PSA levels over 0.2 ng/ml after RP.
Adjuvant or salvage radiotherapy (RT) or hormonal
therapy (HT) were indicated according to institutional
protocols. OS, CSS, CPFS and BRFS were calculated for
the entire cohort and select subGroups using the Kaplan-
Meier method with log-rank test and Cox multivariate
analysis.
Results: The mean age was 66 (range IQR 61.8-71)
years, with no significant differences between Group A and
B. Mean PSA was 30.4 (range IQR 24.4-45) ng/ml. No
differences between the two groups were observed for
pathological stage, positive surgical margins and lymph
node involvement. Mean pathological Gleason score was
significantly higher for Group B (p=0.005). Mean follow-
up was 65.3 (range IQR 46.0–96.5) months. Table I
describes OS, CSS and BRFS at 5 and 10 years for Group
A and B. Only BRFS was significantly higher for Group a
vs. Group B.
Table I. 
Group A Group B p-Value
5-Year 10-Year 5-Year 10-Year 
survival survival survival survival
OS 86% 71% 83% 63% 0.65
CSS 92% 92% 89% 79% 0.67
BRFS 63% 58% 20% 20% 0.012
OS, overal survival; CSS, cancer specific survival; BRFS, biochemical
recurrence-free survival.
Conclusion: RP provided good results in cT3-4 disease.
PSA value at diagnosis in our series could not discriminate
OSS and CSS, while BRFS was lower for patients with a
PSA above 50 ng/ml. This study confirms that RP should
be considered as the first step in a multimodality approach
for locally advanced PC independently on PSA value at
diagnosis.
References
1 Van Poppel H and Joniau S: An analysis of radical
prostatectomy in advanced stage and high-grade prostate
cancer. Eur Urol 53: 253-259, 2008.
2 Gontero P, Marchioro G, Frea B et al: Is radical
prostatectomy feasible in all cases of locally advanced
non-bone metastatic prostate cancer? Results of a single-
institution study. Eur Urol 51: 922-930, 2007.
3 Hsu CY, Joniau S, Oyen R, Roskams T and Van Poppel
H: Outcome of surgery for clinical unilateral T3a
prostate cancer: A single-institution experience. Eur Urol
51(1): 121-128; discussion 128-129, 2007. 
Abstracts of the 20th Annual Meeting of SIUrO, Rome, June 23-25, 2010
1435


RADICAL PROSTATECTOMY FOR PATIENTS WITH CLINICALLY LOCALLY ADVANCED PROSTATE CANCER: SURVIVAL ANALYSIS AND ONCOLOGICAL OUTCOME

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RADICAL PROSTATECTOMY FOR PATIENTS WITH CLINICALLY LOCALLY ADVANCED PROSTATE CANCER: SURVIVAL ANALYSIS AND ONCOLOGICAL OUTCOME

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