Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy Journal Article
| Authors: | Walz, J.; Joniau, S.; Chun, F. K.; Isbarn, H.; Jeldres, C.; Yossepowitch, O.; Chao-Yu, H.; Klein, E. A.; Scardino, P. T.; Reuther, A.; Poppel, H. V.; Graefen, M.; Huland, H.; Karakiewicz, P. I. |
| Article Title: | Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy |
| Abstract: | Study Type - Therapy (outcomes research) Level of Evidence 2b What's known on the subject? and What does the study add? In the current literature, cT3 stage, biopsy Gleason > 8, PSA > 20 ng/ml, and D'Amico high-risk category are frequently used definitions of high-risk prostate cancer. Patients with clinically localized high-risk prostate cancer do not have a uniformly poor prognosis after surgery. The rates of favourable pathological characteristics and biochemical-recurrence free survival vary depending on the definition used for high-risk prostate cancer. OBJECTIVE To investigate the pathological characteristics and the rates of biochemical recurrence (BCR) -free survival after radical prostatectomy (RP) in men with high-risk prostate cancer. METHODS Of 4760 patients treated with RP for prostate cancer at three institutions, 293 patients (6.2%) had clinical stage T3, 269 (5.7%) had a biopsy Gleason sum ≥ 8, 370 (7.8%) had preoperative PSA ≥ 20 ng/mL and 887 (18.6%) were considered high-risk according to the D'Amico classification (clinical stage ≥ T2c or prostate-specific antigen (PSA) ≥ 20 ng/mL or biopsy Gleason sum ≥ 8). Actuarial BCR-free survival probabilities after RP and the rate of favourable pathology (organ-confined cancer, negative surgical margin and Gleason ≤ 7) were assessed. RESULTS Median follow up was 2.4 years and 1179 (24.8%) patients had follow up beyond 5 years. The rate of favourable pathology increased in the following order: clinical stage T3 (13.7%), biopsy Gleason ≥ 8 (16.4%), the DAmico high-risk group (21.4%) and PSA ≥ 20 ng/mL (21.6%). The 5-year BCR-free survival probabilities were 35.4% for Gleason ≥ 8, 39.8% for PSA ≥ 20 ng/mL, 47.4% for DAmico high-risk group and 51.6% for clinical stage T3. Patients with only one risk factor had the most favourable 5-year BCR-free survival (50.3%), relative to patients with two or more risk factors (27.5%) CONCLUSIONS Men with clinically localized high-risk prostate cancer do not have a uniformly poor prognosis after RP. The rate of favourable pathology and of BCR-free survival may vary substantially, depending on the definition used. RP should be considered a valid treatment modality for high-risk prostate cancer patients, as many can be surgically down-staged. © 2010 BJU International. |
| Keywords: | adult; cancer survival; controlled study; aged; survival rate; treatment failure; major clinical study; histopathology; cancer recurrence; postoperative period; cancer staging; recurrence risk; risk factor; high risk patient; prostate cancer; gleason score; prostatectomy; prostate biopsy; radical prostatectomy; biochemical recurrence; high risk |
| Journal Title: | BJU International |
| Volume: | 107 |
| Issue: | 5 |
| ISSN: | 1464-4096 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2011-03-01 |
| Start Page: | 765 |
| End Page: | 770 |
| Language: | English |
| DOI: | 10.1111/j.1464-410X.2010.09594.x |
| PROVIDER: | scopus |
| PUBMED: | 20875089 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 23 June 2011" - "CODEN: BJINF" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
-
671Scardino -
33Yossepowitch
Related MSK Work