Intermediate-risk (IR) prostate cancer is a heterogenous classification with favorable criteria proposed based on men treated with radiation therapy but uncertain application to active surveillance. We quantified the rate of adverse surgical pathology and implications for survival for patients with favorable IR (FIR) compared to low-risk (LR) prostate cancer.
A comparative cohort study of men with prostate cancer (2009-2013) undergoing radical prostatectomy was conducted in the National Cancer Database. The primary endpoint was adverse pathology (≥Grade Group 3 (GG3)/pT3b/pN1). Various FIR definitions were evaluated including the Memorial Sloan Kettering definition (MSK; ≤GG2 with only one IR factor (GG2/cT2b/PSA10-20)), which we have defined as "type 1 IR"; remaining IR patients were "type 2 IR". Log-binomial, logistic, and Cox proportional hazards regression models were employed.
A total of 3,519 (6.8%) of 51,688 LR and 8,888 (20.8%) of 42,720 GG2 IR patients were found to have adverse pathologic findings (RR3.06(95%CI 2.95-3.17;p<0.001)). Stratification by PSA and volume minimally impacted the absolute rate. Results were similar for the MSK definition (type 1 IR). Type 2 IR led to a greater risk of adverse pathology (RR8.52(8.23-8.82;p<0.001) and GG1 IR led to lower risk (RR2.00(1.86-2.16;p<0.001). FIR patients had worse OS compared to LR patients in adjusted models due to adverse pathology.
Adverse pathology at radical prostatectomy is observed at a three-fold higher rate for patients classified as FIR compared to LR leading to worse OS. IR men may be better classified as type 1 and type 2 as none exhibit similar pathologic outcomes to LR men.
The Journal of urology. 2018 Apr 16 [Epub ahead of print]
Hiten D Patel, Mohit Gupta, Jeffrey J Tosoian, H Ballentine Carter, Alan W Partin, Jonathan I Epstein
The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ., The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.