Results of treatment of patients with high-risk prostate cancer: multicenter analysis

Introduction. High-risk prostate cancer (PC) is a life-threatening disease prone to progression and metastatic spread. These patients represent a heterogeneous population with a varying treatment efficacy. Currently, the clinical recommendations of leading associations consider radical prostatectomy (RPE) as a therapeutic option for treatment of patients with high-risk PC (HR-PC). Study objective: to evaluate oncological results in patients with high-risk prostate cancer (HR-PC) after radical surgical treatment depending on the number of prognostic factors, state of lymph nodes and surgical margin after radical prostatectomy (RPE). Materials and methods. This analysis includes treatment outcomes of343 patients assigned to the HR-PC group according to the NCCN criteria (PSA>20 ng/ml and/or Gleason score >8 and / or locally advanced HR-PC>Т3а). All patients underwent radical surgical treatment for localized or locally advanced HR-PC between 2001 and 2019 in three medical facilities with postsurgical follow-up period of more than 12 months. The inclusion criteria were complete information on the histological findings and postsurgical data. Results. The median follow-up was 61 months. In the HR-PC group, the distribution depend-ing on the number of risk factors was as follows: 234 (68.2%) patients had 1 high-risk factor, 87 (25.4%) had 2 factors, and 22 (6.4%) had 3 factors. The five-year relapse-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were 54.8%, 87.0% and 83.7%, respectively. The CSS and OS in the HR-PC group differed depending on one (65.0%, 89.6%, 85.0%), two (38.4%, 85.9%, 84.9%) and three (13.0%, 65.2%, 65.2%) risk factors, respectively. The presence of more than one preoperative factor for high-risk PC was a signifi-cant unfavourable prognostic sign for RFS, and the presence of more than two factors - for CSS and OS. Differences in patients with one or two risk factors were not significant for both CSS (p=0.3537) and OS (p=0.8875). Conclusion. Despite the differences in oncological outcomes between different risk groups, the high-risk group is not homogeneous and a number of patients will receive long-term stabili-zation after surgical treatment, while others will require a comprehensive approach. Our out-comes show good cancer health indicators after RPE in patients with 1-2 high-risk factors.