Progresión metastática, mortalidad cáncer específica y necesidad de tratamientos de segunda línea en pacientes con cáncer de próstata de alto riesgo tratados inicialmente mediante prostatectomía radical

purpose: to determine our results in high risk (hr) prostate cancer (pca) patients treated with radical prostatectomy (rp) and to establish preoperative prognosis factors. material and methods: retrospective study of 925 rp. mean follow-up for the hr group was 89.8+/-53.6 months. following nccn criteria, we operated 210 (22.7%) hr and 715 (77.3%) low/intermediate risk patients. end point was metastatic progression. kaplan-meier method for survival comparison among groups and cox regression model for multivariate analysis of preoperative prognostic factors were used. results: revised period; 1986-2007. fifty-four patients (25.7%) were free of disease and 8 patients (3.8%) died for other causes free of disease. disease progressed in 148 patients (70.5%); death due to tumour progression occurred in 42 cases (20%) and due to other causes in 25 patients (11.9%). seventy-nine patients in hr group (38%) vs 549 low/intermediate risk group (78.5%) did not deserve further treatments (p<0.001). the uni and multivariate analysis for metastatic progression showed both gleason score at biopsy (rr=1.922; 95% ci 1.106-3.341, p=0.020) and clinical stage (rr=2.290; 95% ci 1.269-4.133, p=0.006) showed independent prognostic value for metastatic progression, but not psa. conclusions: a hr patient can be cured in a third of the cases and will need multimodal treatments in more than half of the times. we prompt surgery in a young healthy patient with a resectable tumour, mainly if just one bad prognostic factor is present and defiantly if this is just psa elevation.