Department of Urology, APHP, CHU Henri Mondor, Créteil, France.
Institut National de la Sante et de la Recherche Medicale, Université Paris 12, Créteil, France.
To estimate the effect of predictive factors for oncologic outcomes after radical prostatectomy (RP) for high-risk prostate cancer (PCa).
A total of 813 patients underwent RP for high-risk PCa in a national retrospective multi-institutional study. High-risk PCa was defined as follows: prostate-specific antigen (PSA) level >20 ng/mL, Gleason score 8-10, and/or clinical Stage T2c-T4 disease. The preoperative criteria of high-risk PCa were studied in a logistic regression model to assess the correlations with the pathologic findings in the RP specimens. The predictive factors isolated or combined in scores were assessed by Cox multivariate and Kaplan-Meier analyses in predicting PSA failure (recurrence-free survival [RFS]) and overall survival (OS).
The median follow-up was 64 months. Organ-confined disease was reported in 36.5%. The 5-year RFS, metastasis-free survival, and OS rate was 74.1%, 96.1%, and 98.6%, respectively. Each preoperative criteria of high-risk PCa was an independent predictor of PSA failure. The PSA failure risk was increased by 1.5- and 2.8-fold in men with 2 and 3 criteria, respectively. The RFS, but not the OS, was significantly different according to the preoperative score (P < .001). The postoperative score was significantly predictive for RFS and OS (P < .001 and P < .035, respectively). The risk of PSA failure was significantly increased with an increasing postoperative score (2-4.6-fold).
National data support evidence that RP can result in encouraging midterm oncologic outcomes for the management of high-risk PCa. At 5 years after surgery, 75% of patients remain disease free. Our easy-to-use risk stratification might help clinicians to better predict the clinical and PSA outcomes of high-risk patients after surgery.
Written by:
Ploussard G, Masson-Lecomte A, Beauval JB, Ouzzane A, Bonniol R, Buge F, Fadli S, Rouprêt M, Rebillard X, Gaschignard N, Pfister C, Villers A, Soulié M, Salomon L. Are you the author?
Reference: Urology. 2011 Jul 21. Epub ahead of print.
doi: 10.1016/j.urology.2011.05.021
PubMed Abstract
PMID: 21783233
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