OBJECTIVES: Early biochemical recurrence (BCR) after radical prostatectomy (RP) might be associated with higher risk of metastases and cancer-specific mortality.
The aim of the current study is to examine whether percentage of tumor volume (%TV) and percentage of high-grade tumor volume (%HGTV) help to better identify men at higher risk of early BCR after RP for non-metastatic high-risk prostate cancer (PCa).
PATIENTS AND METHODS: We examine data of 595 men treated with RP for non-metastatic high-risk PCa between 1992-2011 at two European tertiary care centers. Kaplan-Meier analyses are used to graphically depict 2-year-BCR-free survival. Multivariable Cox regression models addressed early BCR. We test whether addition of %TV and %HGTV to a multivariable Cox regression model helps to increase a model's predictive accuracy (PA) for prediction of early BCR.
RESULTS: Thirty-two men (10%) with specimen-confined PCa (pT2-pT3a, SM-, pN0) and 67 men (24%) with non-specimen-confined PCa experience early BCR. After stratification according to %HGTV (%HGTV cut-off: ≤ 33.33 vs. >33.33%), 2-year BCR-free survival rates are respectively 93 vs. 60% (log rank p< 0.001). In multivariable Cox regression models %HGTV emerges as independent predictor of early BCR (p< 0.001), whereas %TV does not (p>0.05). However, adding %HGTV (regardless of its coding) to other covariates in multivariable Cox regression analysis does not increase the model's PA in a meaningful fashion compared to the use of the detailed Gleason grading system (6 vs. 7a vs. 7b vs. 8 vs. 9-10).
CONCLUSIONS: In a large cohort of high-risk PCa patients, %HGTV and %TV does not improve prediction of early BCR after RP substantially, even though %HGTV appears to be an independent predictor of early BCR. Therefore, the sophisticated TV/HGTV measurement does not seem to carry additional benefit for early BCR prediction relative to the use of Gleason grading. However, these results need to be confirmed in larger, prospective studies.
Written by:
Hansen J, Bianchi M, Sun M, Rink M, Castiglione F, Abdollah F, Steuber T, Ahyai SA, Steurer S, Göbel C, Freschi M, Montorsi F, Shariat SF, Fisch M, Graefen M, Karakiewicz PI, Briganti A, Chun FK. Are you the author?
Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
Reference: BJU Int. 2013 Aug 23. Epub ahead of print.
doi: 10.1111/bju.12424
PubMed Abstract
PMID: 24053339
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