针对临床(c)T4前列腺癌患者进行评估，这些患者是异质且研究不足的人群，通常出现局部晚期疾病和阻塞性症状，导致重大的病死率。我们分析了接受明确的局部治疗是否影响症状和肿瘤学结果。回顾性分析了1996-2020年在一家医疗机构接受治疗的154名cT4前列腺癌患者。采用有或无局部治疗（手术、放疗或两者）的系统治疗。采用Cox回归对临床病理特征（包括阻塞性症状）和接受局部治疗对总生存（OS）和疾病控制的关联进行了一元和多元分析。中位随访时间为5.9年。大多数患者是腺癌（88％），格里森9-10（77％）和中位基线前列腺特异性抗原（PSA）为20 ng / mL；大多数（54％）患有转移性cT4N0-1M1疾病； 24％的区域晚期cT4N1M0和22％的局部cT4N0M0疾病。局部治疗包括放疗（n = 44）、手术（n = 28）或两者（n = 9）。局部治疗与改善OS（危险比[HR] 0.3，P <0.001）、更长的局部复发自由期（HR 0.39，P = 0.002）、更少的局部进展（HR 0.41，P = 0.02）、发展中的阻塞性症状更少（HR 0.31，P = 0.01）以及死于局部疾病更少（HR 0.25，P = 0.002）有关。在多元分析中，局部治疗与改善生存有关（HR 0.58，P = 0.02），而转移性疾病（HR 2.93，P <0.001）或高风险病理（HR 2.05，P = 0.03）与生存较差有关。对于cT4前列腺癌的明确局部治疗即使对于具有转移性疾病的男性，也与改善症状结果和生存有关。在进行前瞻性评估之前，这些发现支持在特定情况下采用局部治疗进行cT4疾病的明确治疗。本文章受版权保护。保留所有权利。

To evaluate clinical (c)T4 prostate cancer patients, which represent both a heterogenous and understudied population, who often present with locally advanced disease and obstructive symptoms causing significant morbidity and mortality. We analyzed whether receiving definitive local therapy influenced symptomatic and oncologic outcomes.Retrospective analysis of 154 patients with cT4 prostate cancer treated at a single institution in 1996-2020. Systemic therapy with or without local treatment (surgery, radiation, or both). Univariate and multivariate analyses of associations between clinicopathologic features (including obstructive symptoms) and receipt of local therapy on overall survival (OS) and disease control were done with Cox regression.Median follow-up time was 5.9 years. Most patients had adenocarcinoma (88%), Gleason 9-10 (77%), and median baseline prostate-specific antigen (PSA) of 20 ng/mL; most (54%) had metastatic cT4N0-1M1 disease; 24% regionally advanced cT4N1M0, and 22% localized cT4N0M0. Local therapies were radiation (n=44), surgery (n=28), or both (n=9). Local therapy was associated with improved OS (hazard ratio[HR] 0.3,-p<0.001), longer freedom from local recurrence (HR 0.39,_p=0.002), less local progression (HR 0.41, p=0.02), fewer obstructive symptoms with progression (HR 0.31,_p=0.01), and less death from local disease (HR 0.25,-p=0.002). On MVA, local therapy was associated with improved survival (HR 0.58, p=0.02), and metastatic disease (HR 2.93, p<0.001) or high-risk pathology (HR 2.05,-p=0.03) was associated with worse survival.Definitive local therapy for cT4 prostate cancer was associated with improved symptomatic outcomes and survival even among men with metastatic disease. Pending prospective evaluation, these findings support definitive treatment with local therapy for cT4 disease in select cases.This article is protected by copyright. All rights reserved.