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EAU 2017

EAU 2017: Predictors of early cancer specific and other cause mortality in high risk prostate cancer patients after radical prostatectomy: Results from a large, multi-institutional analysis

London, England (UroToday.com) High-risk prostate cancer continues to represent a heterogeneous patient population. Outcomes after high-risk prostate cancer treatment vary significantly. As such, the authors aim to identify predictors of early cancer-specific mortality (defined as  5 years) (CSM) and other-cause mortality (OCM) after RP. Specifically, they used a multi-institutional database (from European and US institutions).

2280 men with HRPCa who were treated with primary radical prostatectomy (RP) and lymphadenectomy (LND) were included. Competing risks analysis assessing CSM and OM included: age, charlson comorbidity index, pT stage, surgical margin (SM), pathologic Gleason score (GS), lymph node invasion (LNI), time to BCR, and any adjuvant therapy. Unfortunately, LND extent was not assessed.

Median follow-up was 210 months (17.5 years). A very nice Kaplan-Meier figure demonstrates 20 year CSM and OCM (17.5% and 49.5%, respectively); at 5 years, those numbers were 55 (2.9%) and 69 (3.7%), respectively. Pathological GS 8-10 (HR=14.14), time to BCR (HR=0.95), LNI (HR=3.35), and positive SM (HR=2.23) were significant predictors of early CSM (all p≤0.01). Using these factors, they generated the following nomogram: pathological GS (8-10 vs. 7 vs. 6; 2, 1 and 0 points, respectively), time to BCR (≤36 vs. >36; 1 and 0 point, respectively), LNI (present vs. absent; 1 and 0 points, respectively) and SM (positive vs. negative; 1 and 0 points, respectively). The 5-year CSM-rates differed according to the risk score, as expected, and they indicate that this can help counsel patients and guide the need for adjuvant therapy.

Limitations / Discussion / Future Directions:

1. Unfortunately, high-risk was never clearly defined in the poster or presentation. Indeed, a small proportion of patients had Gleason 6 disease, including in those men who had early CSM. This needs to be further clarified by the authors.
2. LND extent was not assessed as a variable, nor was it commented on.

Presented by: M. Bianchi

Co-authors: Gandaglia G., Fossati N., Dell'Oglio P., Joniau S., Colicchia M., Munegato S., Bandini M., Spahn M., Scattoni V., Gontero P., Karnes J., Montorsi F., Briganti A.

Institutuions:
1. Vita-Salute University San Raffaele; Magna Graecia University, Dept. of Urology, Milan, Italy
2. University Hospital of Leuven, Dept. of Urology, Leuven, Belgium
3. Mayo Clinic, Dept. of Urology, Rochester, United States of America
4. University of Turin, Dept. of Urology, Turin, Italy
5. Vita-Salute University San Raffaele, Dept. of Urology, Milan, Italy
6. University Hospital of Bern, Dept. of Urology, Bern, Switzerland


Written by: Thenappan Chandrasekar, Clinical Fellow, University of Toronto

at the #EAU17 -March 24-28, 2017- London, England