Title: Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy
Authors: Walz, Jochen ×
Joniau, Steven
Chun, Felix K
Isbarn, Hendrik
Jeldres, Claudio
Yossepowitch, Ofer
Chao-Yu, Hsu
Klein, Eric A
Scardino, Peter T
Reuther, Alwyn
Van Poppel, Hendrik
Graefen, Markus
Huland, Hartwig
Karakiewicz, Pierre I #
Issue Date: Mar-2011
Publisher: Blackwell Science
Series Title: BJU International vol:107 issue:5 pages:765-770
Article number: 10.1111/j.1464-410X.2010.09594.x
Abstract: Study Type - Therapy (outcomes research)‚Ä®Level of Evidence 2b
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 D'Amico 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 D'Amico 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.
ISSN: 1464-4096
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Urology Section (-)
× corresponding author
# (joint) last author

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