From the Guidelines
The prognosis for a patient with prostate cancer with extraprostatic extension, classified as pT3a(Nx)Mx, is generally guarded but varies based on individual factors, with a 5-year biochemical recurrence-free survival rate of approximately 50-70%. This staging indicates the tumor has extended beyond the prostate capsule (pT3a) but lymph node status (Nx) and distant metastasis status (Mx) are unknown. Patients with this staging typically require a multimodal approach for treatment, including radical prostatectomy often followed by adjuvant or salvage radiation therapy, as suggested by the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of prostate cancer 1. Androgen deprivation therapy may be added depending on risk factors such as Gleason score, PSA level, and surgical margin status.
Key factors influencing prognosis include:
- PSA levels at diagnosis
- Gleason score
- Surgical margin status
- Presence of seminal vesicle invasion or extraprostatic extension
Close monitoring with regular PSA testing every 3-6 months for the first 5 years is essential, as early detection of recurrence improves outcomes, as noted in the NCCN clinical practice guidelines in oncology: prostate cancer 2. The extraprostatic extension indicates locally advanced disease, which carries a higher risk of recurrence than organ-confined disease. However, outcomes have improved significantly with modern treatment approaches combining surgery, radiation, and hormonal therapy when appropriate, as highlighted in the ASTRO/AUA guideline amendment 2018-2019 on adjuvant and salvage radiotherapy after prostatectomy 3.
Treatment strategies should be individualized based on the patient's specific risk factors and disease characteristics. The decision to use adjuvant or salvage radiation therapy, androgen deprivation therapy, or a combination of these treatments should be made after careful consideration of the potential benefits and risks, taking into account the patient's overall health, preferences, and quality of life.
From the Research
Prognosis for Prostate Cancer with Extraprostatic Extension
The prognosis for a patient with prostate cancer with extraprostatic extension, classified as pT3a(Nx)Mx, can be determined by analyzing the provided evidence.
- The study 4 found that extraprostatic extension (EPE) on prostate biopsies is an uncommon finding, but is strongly correlated to additional aggressive disease features, and accurately predicts the presence of EPE in radical prostatectomy specimens.
- Despite the associated high-risk features, finding EPE in prostate biopsies should not preclude patients from undergoing curative-intent radical local therapy, as the 5-year biochemical recurrence and metastasis rates were 25.6% and 7% for radical prostatectomy, and 11.9% and 11.9% for radiotherapy, respectively.
- However, the provided studies do not directly address the prognosis for a patient with pT3a(Nx)Mx prostate cancer, as they focus on different aspects of prostate cancer treatment, such as combination therapies for metastatic hormone-sensitive prostate cancer 5, combining abiraterone and radiotherapy for metastatic castration-resistant prostate cancer 6, and taxane-based combination therapies for metastatic prostate cancer 7.
- Additionally, the study 8 discusses the efficacy of combining prostate-targeted treatment and metastasis-directed therapy for oligometastatic prostate cancer, but does not specifically address the prognosis for pT3a(Nx)Mx prostate cancer.
Treatment Outcomes
The treatment outcomes for patients with extraprostatic extension can vary depending on the treatment approach.
- The study 4 found that radical prostatectomy and radiotherapy can achieve favorable outcomes, with 5-year biochemical recurrence rates of 25.6% and 11.9%, respectively.
- The study 8 found that combining prostate-targeted treatment and metastasis-directed therapy can result in favorable long-term disease-free and survival outcomes, with an 8-year overall survival rate of 64.8% and a castration-resistant prostate cancer-free rate of 67.3%.