Radical retropubic prostatectomy plus orchiectomy versus orchiectomy alone for pTxN+ prostate cancer

A matched comparison

Reza Ghavamian, Erik J. Bergstralh, Michael L. Blute, Jeff Slezak, Horst Zincke

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Purpose: Untreated stage pTxN+ prostate cancer is associated with a poor outcome. Monotherapy (surgery, radiation, hormonal therapy) alone is associated with a high progression rate. We evaluate whether radical prostatectomy and pelvic lymphadenectomy plus early adjuvant orchiectomy impart a survival advantage compared to pelvic lymphadenectomy and orchiectomy alone in a matched cohort of patients. Materials and Methods: Between 1966 and 1995, 382 and 79 patients with stage pTxN+ prostate cancer underwent pelvic lymphadenectomy and radical prostatectomy plus early adjuvant orchiectomy (within 3 months of prostatectomy), and pelvic lymphadenectomy and orchiectomy only, respectively. We selected 79 matched controls from the prostatectomy plus orchiectomy group for the orchiectomy group. Patients were matched according to the number of positive nodes, clinical grade, clinical stage, age, year of surgery and preoperative prostate specific antigen (after 1987). The Kaplan-Meier method and stratified Cox proportional hazards model were used to estimate overall and cause specific survival for the 2 groups. Results: There was an overall survival advantage at 10 years for the prostatectomy plus orchiectomy (66 ± 6%) compared to the orchiectomy (28 ± 6%) group (p <0.001, risk ratio 0.36, 95% confidence interval 0.20 to 0.66). There was also an advantage in cause specific survival at 10 years in the prostatectomy plus orchiectomy (79 ± 5%) versus the orchiectomy (39 ± 7%) group (p <0.001, relative risk 0.28, 95% confidence interval 0.13 to 0.59). After 1987, when matched on preoperative prostate specific antigen, the apparent survival advantage at 5 years with radical prostatectomy was smaller (79 ± 8 versus 63 ± 9% orchiectomy) and not significant (p = 0.19). Conclusions: This retrospective study of patients with stage pTxN+ PC suggests that radical prostatectomy with early adjuvant orchiectomy may provide a significant advantage in overall and cause specific survival compared to orchiectomy alone.

Original languageEnglish (US)
Pages (from-to)1223-1228
Number of pages6
JournalJournal of Urology
Volume161
Issue number4
DOIs
StatePublished - 1999

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Orchiectomy
Prostatectomy
Prostatic Neoplasms
Lymph Node Excision
Survival
Prostate-Specific Antigen
Confidence Intervals
Proportional Hazards Models
Radiotherapy
Retrospective Studies

Keywords

  • Adenocarcinoma
  • Lymph nodes
  • Orchiectomy
  • Prostate

ASJC Scopus subject areas

  • Urology

Cite this

Radical retropubic prostatectomy plus orchiectomy versus orchiectomy alone for pTxN+ prostate cancer : A matched comparison. / Ghavamian, Reza; Bergstralh, Erik J.; Blute, Michael L.; Slezak, Jeff; Zincke, Horst.

In: Journal of Urology, Vol. 161, No. 4, 1999, p. 1223-1228.

Research output: Contribution to journalArticle

Ghavamian, Reza ; Bergstralh, Erik J. ; Blute, Michael L. ; Slezak, Jeff ; Zincke, Horst. / Radical retropubic prostatectomy plus orchiectomy versus orchiectomy alone for pTxN+ prostate cancer : A matched comparison. In: Journal of Urology. 1999 ; Vol. 161, No. 4. pp. 1223-1228.
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abstract = "Purpose: Untreated stage pTxN+ prostate cancer is associated with a poor outcome. Monotherapy (surgery, radiation, hormonal therapy) alone is associated with a high progression rate. We evaluate whether radical prostatectomy and pelvic lymphadenectomy plus early adjuvant orchiectomy impart a survival advantage compared to pelvic lymphadenectomy and orchiectomy alone in a matched cohort of patients. Materials and Methods: Between 1966 and 1995, 382 and 79 patients with stage pTxN+ prostate cancer underwent pelvic lymphadenectomy and radical prostatectomy plus early adjuvant orchiectomy (within 3 months of prostatectomy), and pelvic lymphadenectomy and orchiectomy only, respectively. We selected 79 matched controls from the prostatectomy plus orchiectomy group for the orchiectomy group. Patients were matched according to the number of positive nodes, clinical grade, clinical stage, age, year of surgery and preoperative prostate specific antigen (after 1987). The Kaplan-Meier method and stratified Cox proportional hazards model were used to estimate overall and cause specific survival for the 2 groups. Results: There was an overall survival advantage at 10 years for the prostatectomy plus orchiectomy (66 ± 6{\%}) compared to the orchiectomy (28 ± 6{\%}) group (p <0.001, risk ratio 0.36, 95{\%} confidence interval 0.20 to 0.66). There was also an advantage in cause specific survival at 10 years in the prostatectomy plus orchiectomy (79 ± 5{\%}) versus the orchiectomy (39 ± 7{\%}) group (p <0.001, relative risk 0.28, 95{\%} confidence interval 0.13 to 0.59). After 1987, when matched on preoperative prostate specific antigen, the apparent survival advantage at 5 years with radical prostatectomy was smaller (79 ± 8 versus 63 ± 9{\%} orchiectomy) and not significant (p = 0.19). Conclusions: This retrospective study of patients with stage pTxN+ PC suggests that radical prostatectomy with early adjuvant orchiectomy may provide a significant advantage in overall and cause specific survival compared to orchiectomy alone.",
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T1 - Radical retropubic prostatectomy plus orchiectomy versus orchiectomy alone for pTxN+ prostate cancer

T2 - A matched comparison

AU - Ghavamian, Reza

AU - Bergstralh, Erik J.

AU - Blute, Michael L.

AU - Slezak, Jeff

AU - Zincke, Horst

PY - 1999

Y1 - 1999

N2 - Purpose: Untreated stage pTxN+ prostate cancer is associated with a poor outcome. Monotherapy (surgery, radiation, hormonal therapy) alone is associated with a high progression rate. We evaluate whether radical prostatectomy and pelvic lymphadenectomy plus early adjuvant orchiectomy impart a survival advantage compared to pelvic lymphadenectomy and orchiectomy alone in a matched cohort of patients. Materials and Methods: Between 1966 and 1995, 382 and 79 patients with stage pTxN+ prostate cancer underwent pelvic lymphadenectomy and radical prostatectomy plus early adjuvant orchiectomy (within 3 months of prostatectomy), and pelvic lymphadenectomy and orchiectomy only, respectively. We selected 79 matched controls from the prostatectomy plus orchiectomy group for the orchiectomy group. Patients were matched according to the number of positive nodes, clinical grade, clinical stage, age, year of surgery and preoperative prostate specific antigen (after 1987). The Kaplan-Meier method and stratified Cox proportional hazards model were used to estimate overall and cause specific survival for the 2 groups. Results: There was an overall survival advantage at 10 years for the prostatectomy plus orchiectomy (66 ± 6%) compared to the orchiectomy (28 ± 6%) group (p <0.001, risk ratio 0.36, 95% confidence interval 0.20 to 0.66). There was also an advantage in cause specific survival at 10 years in the prostatectomy plus orchiectomy (79 ± 5%) versus the orchiectomy (39 ± 7%) group (p <0.001, relative risk 0.28, 95% confidence interval 0.13 to 0.59). After 1987, when matched on preoperative prostate specific antigen, the apparent survival advantage at 5 years with radical prostatectomy was smaller (79 ± 8 versus 63 ± 9% orchiectomy) and not significant (p = 0.19). Conclusions: This retrospective study of patients with stage pTxN+ PC suggests that radical prostatectomy with early adjuvant orchiectomy may provide a significant advantage in overall and cause specific survival compared to orchiectomy alone.

AB - Purpose: Untreated stage pTxN+ prostate cancer is associated with a poor outcome. Monotherapy (surgery, radiation, hormonal therapy) alone is associated with a high progression rate. We evaluate whether radical prostatectomy and pelvic lymphadenectomy plus early adjuvant orchiectomy impart a survival advantage compared to pelvic lymphadenectomy and orchiectomy alone in a matched cohort of patients. Materials and Methods: Between 1966 and 1995, 382 and 79 patients with stage pTxN+ prostate cancer underwent pelvic lymphadenectomy and radical prostatectomy plus early adjuvant orchiectomy (within 3 months of prostatectomy), and pelvic lymphadenectomy and orchiectomy only, respectively. We selected 79 matched controls from the prostatectomy plus orchiectomy group for the orchiectomy group. Patients were matched according to the number of positive nodes, clinical grade, clinical stage, age, year of surgery and preoperative prostate specific antigen (after 1987). The Kaplan-Meier method and stratified Cox proportional hazards model were used to estimate overall and cause specific survival for the 2 groups. Results: There was an overall survival advantage at 10 years for the prostatectomy plus orchiectomy (66 ± 6%) compared to the orchiectomy (28 ± 6%) group (p <0.001, risk ratio 0.36, 95% confidence interval 0.20 to 0.66). There was also an advantage in cause specific survival at 10 years in the prostatectomy plus orchiectomy (79 ± 5%) versus the orchiectomy (39 ± 7%) group (p <0.001, relative risk 0.28, 95% confidence interval 0.13 to 0.59). After 1987, when matched on preoperative prostate specific antigen, the apparent survival advantage at 5 years with radical prostatectomy was smaller (79 ± 8 versus 63 ± 9% orchiectomy) and not significant (p = 0.19). Conclusions: This retrospective study of patients with stage pTxN+ PC suggests that radical prostatectomy with early adjuvant orchiectomy may provide a significant advantage in overall and cause specific survival compared to orchiectomy alone.

KW - Adenocarcinoma

KW - Lymph nodes

KW - Orchiectomy

KW - Prostate

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