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Title: Time to biochemical recurrence is a strong and independent predictor of css and os in high-risk prostate cancer
Authors: Spahn, M
Gontero, P
Briganti, A
Marchioro, G
Tombal, B
Walz, J
Hsu, C. Y
Bader, P
Frohneberg, D
Graefen, M
Tizzani, A
Van Cangh, P
Montorsi, F
Van Poppel, Hendrik
Joniau, Steven #
Issue Date: Mar-2011
Publisher: Elsevier science bv
Host Document: European urology supplements vol:10 issue:2 pages:217-217
Conference: Annual EAU Congress edition:26 location:Vienna date:18-22 March 2011
Article number: 675
Abstract: Introduction & Objectives: Even though more than half of the patients with highrisk
prostate cancer develop biochemical recurrence (BCR) after surgery, the
outcome of those who fail is not invariably poor. This study aimed to assess the
value of time to BCR as a predictor of cancer-specific survival (CSS) and overall
survival (OS) in high-risk PCa patients, treated with radical prostatectomy (RP).
Materials & Methods: The study included 1584 patients with pre-operative high
risk prostate cancer (PSA>20 ng/ml or cT3-4 or biopsy Gleason 8-10) treated with
RP and pelvic LND at 7 tertiary referral centers between 1987 and 2009. Adjuvant
and salvage radiotherapy (RT) and hormonal treatment (HT) were administered
according to institutional protocols. BCR was defined as PSA>0.2 ng/ml on two
subsequent measurements.
Results: Mean age at surgery was 65.4 yrs(median 66 yrs; range 41-89). Mean
preop PSA was 33.5 ng/ml (median 22.8 ng/ml; range 1-1710 ng/ml). Final Gleason
sum was 2-6, 7 and 8-10 in 32.3, 37.7 and 30.0%, respectively. Pathological stage
was T2, T3a and >T3a in 23.5, 33.0 and 43.5%, respectively. 24.2% had lymph
node invasion and 47.5% had positive surgical margins. Adjuvant RT and HT were
administered in 22.1 and 46.4%, respectively. At a mean follow up of 67.1 months
(median 62 months; range 1-206), BCR occurred in 33%. CSS was significantly
worse in patients with BCR occurring within 2 years from surgery (n=278, 17.7%),
compared to those with BCR occurring beyond 2 years (n=239, 15.3%) (10-
year CSS 73.2% vs 85.3%, p=0.0008). When the analysis was repeated for the
subgroup of 406 patients who did not receive any (neo-) adjuvant treatment, results
were even more pronounced with 10-year CSS of 77.2% for the group of patients
with BCR ≤2 yrs versus 100% for the other groups (p<0.0001). OS of patients with
BCR >2 yrs was identical compared to patients who never experienced BCR in
follow-up (10-year OS 75.9% vs 81.4%, p=0.83), while OS of patients with BCR ≤2
yrs from surgery was significantly worse (10-year OS 58.3% vs. 81.4%, p<0.0001).
BCR ≤2 yrs (p<0.0001, HR 4,5191 (95% CI 2,9494 to 6,9240) was the strongest
independent predictor of CSS in the Cox multivariable model, correcting for PSA,
pathological stage and Gleason sum, lymph node invasion and surgical margins.
Conclusions: Outcome of high risk prostate cancer is not invariably poor.
However, about 1 in 5 patients experience biochemical recurrence within 2 years
from surgery. This group is at significantly elevated risk for cancer related death,
and should be considered for trials assessing aggressive systemic treatment
strategies.
URI: 
ISSN: 1569-9056
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Urology Section (-)
# (joint) last author

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