Materials and Methods: Using a stratified cohort sampling design, we evaluated the association of AP with the risk of distant metastasis (DM) and prostate cancer-specific mortality (PCSM) up to 20 years after RP in 428 patients treated between 1987 to 2004. Cox regression of cause-specific hazards was used to estimate the absolute risk of both endpoints, with death from other causes treated as a competing risk. Additionally, subgroup analysis in patients with low and/or intermediate-risk disease, who are potentially eligible for active surveillance (AS), was performed.
Results: Within the cohort sample, 53% of men exhibited AP at time of RP, with median follow up of 15.5 years (IQR 14.6-16.6 years) thereafter. Adverse pathology was highly associated with DM and PCSM in the overall cohort (HR 12.30, 95% confidence interval [CI] 5.30-28.55, and HR 10.03, 95% CI 3.42-29.47, respectively, both P < 0.001). Adverse pathology was also highly associated with DM and PCSM in the low/intermediate-risk subgroup (HR 10.48, 95% CI 4.18-26.28, and 8.60, 95% CI 2.40-30.48, respectively, both P < 0.001).
Conclusions: Adverse pathology at the time of RP is highly associated with future development of DM and PCSM. Accurate prediction of AP may thus be useful for individualizing risk-based surveillance and treatment strategies.
Michael A. Brooks M.D.1 Lewis Thomas M.D.2 Cristina Magi-Galluzzi M.D., Ph.D.3 Jianbo Li Ph.D.4 Michael R. Crager Ph.D.5 Ruixiao Lu Ph.D.5 Frederick L. Baehner M.D.5 John Abran M.D., Ph.D.5 Tamer Aboushwareb M.D., Ph.D.5 Eric A. Klein M.D.6
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
- Division of Urologic Surgery, Washington University in St. Louis, St. Louis, MO
- Department of Anatomic Pathology, University of Alabama Birmingham, Birmingham, AL
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
- Exact Sciences Corporation, Redwood City, CA
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH