How have we treated pathological T1 (pT1) prostate cancer (CaP) in recent 10 years?

Abstract

Objective: To review the treatment modality and outcome of patients with pT1 CaP.

Patients & Methods: Data of transurethral resection of prostate (TURP) performed from April 2000 to December 2009 were reviewed. Pathological results of resected specimen were reviewed on electronic patient record (ePR) system and data of patients with pT1 CaP were retrieved. Kaplan-Meier model was used to compare survival.

Results: During the period, 178 patients were diagnosed pT1 prostate cancer with median follow-up time of 57.5 months. Median age at TURP was 77 years old. 97 (54.5%) patients had pT1a CaP and 65 (36.5%) had pT1b CaP; extent of tumour involvement was not reported in 16 (9%) specimens. 9 (5.1%) patients underwent curative treatment – radical prostatectomy (RP) (2.2%) or radical radiotherapy (RT) (3.4%); 48 (27.5%) received palliative treatment – bilateral simple orchidectomy (BSO) (13.2%), anti-androgen monotherapy (10.7%) and luteinizing hormone receptor hormone antagonist (LHRHa) injection (3.4%); 5 (2.8%) patients had active surveillance (AS) and 111 (62.4%) decided for watchful waiting (WW). Most patients died of CaP-unrelated causes. The overall and disease-specific 5-year survival were 33% and 100% for RP, 42% and 83% for RT, 10% and 48% for BSO, 12% and 100% for anti-androgen monotherapy, 67% and 100% for LHRHa, 100% and 100% for AS, and 45% and 92% for WW, respectively.

Conclusions: Most patients with pT1 CaP died of CaP-unrelated causes. Treatment plan should be discussed with patients with balance of survival benefit, benefit in improving quality of life and complications of treatment.