OBJECTIVE: To identify appropriate risk stratification system for intermediate-risk prostate cancer (PCa).
PATIENTS AND METHODS: Classifying patients according to National Comprehensive Cancer Network (NCCN) risk groups, we reviewed data of 1559 radical prostatectomy (RP) patients who were treated at our institution from 2005 to 2013. For our analyses, intermediate-risk PCa meeting at least one of two following factors were designated as unfavorable intermediate-risk disease: biopsy Gleason score 4 + 3 and/or multiple (≥ 2) intermediate-risk criteria present. All other men with intermediate-risk PCa were designated as having favorable intermediate-risk disease. Postoperative outcomes including biochemical recurrence (BCR)-free survivals were calculated and compared via log-rank test and Cox proportional hazards model.
RESULTS: In multivariable analysis, biopsy Gleason score 4 + 3 and multiple (≥ 2) intermediate-risk criteria were observed to be independent predictors of the risk of BCR amongst intermediate-risk group undergoing RP. Favorable intermediate-risk group showed a significantly higher 5-year BCR-free survival than unfavorable group (87.5% vs 66.5%) (p < 0.001). Unfavorable intermediate-risk group showed significantly higher 5-year BCR-free survival than high-risk group (66.5% vs. 47.9%) (p < 0.001) while favorable intermediate-risk group demonstrated significantly lower 5-year BCR-free survival than low-risk group (87.5% vs. 93.5%) (p = 0.002).
CONCLUSIONS: A significant heterogeneity exists in biochemical outcomes of contemporary patients with intermediate-risk PCa who underwent definitive RP. According to biopsy Gleason score and number of intermediate-risk criteria present, intermediate-risk group should be stratified into favorable and unfavorable disease.
Written by:
Jung JW, Lee JK, Hong SK, Byun SS, Lee SE. Are you the author?
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Reference: BJU Int. 2014 Feb 25. Epub ahead of print.
doi: 10.1111/bju.12703
PubMed Abstract
PMID: 24612460
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