Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy
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 #
BJU International vol:107 issue:5 pages:765-770
Study Type - Therapy (outcomes research) 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.