BACKGROUND: Subclassification of the extent of extraprostatic extension (EPE) in radical prostatectomy (RP) specimens may enhance prognostication for prostate cancer (PCa) patients.
Yet optimal criteria for staging, validation within a large cohort, and long-term follow-up are lacking.
OBJECTIVE: To compare biochemical recurrence-free survival (BRFS), PCa-specific survival (PCSS), and overall survival (OS) for focal EPE (pT3aF) and nonfocal EPE (pT3aNF) in a large tertiary-referral center with the Epstein criteria for EPE extent.
DESIGN, SETTING, AND PARTICIPANTS: Between 1982 and 2012, 20 434 men underwent RP, and 15 565 men (76.2%) had available pathologic and survival data. A total of 4216 men with isolated EPE were subclassified into pT3aF (1869 men, 44%) and pT3aNF (2347 men, 56%).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Predictors of BRFS, PCSS, and OS were identified with multivariate Cox proportional hazard models. Covariates included age, preoperative prostate-specific antigen, body mass index, surgery year, Gleason score, and surgical margin status.
RESULTS AND LIMITATIONS: With a median follow-up of 9.0 yr (range: 1-27), 314 men died of PCa, with 1300 deaths from any cause. In a multivariate model, pT3aNF compared with pT3aF was an independent predictor of BRFS (hazard ratio [HR]: 1.39; 95% confidence interval [CI], 1.18-1.62; p< 0.001), but not of PCSS (HR: 1.38; 95% CI, 0.89-2.11; p=0.146) or OS (HR: 1.13; 95% CI, 0.94-1.36; p=0.197). Ten-year BRFS, PCSS, and OS for pT3aF and pT3aNF were 76% versus 59%, 98% versus 96%, and 95% versus 90%, respectively.
CONCLUSIONS: In a large RP cohort, subclassification of EPE extent with the Epstein criteria improves correlation with BRFS. PCSS and OS in men with isolated EPE (pT3a) are excellent and are not significantly different between pT3aF and pT3aNF. The EPE extent should be subclassified to identify a subgroup of men with a higher risk of recurrence (pT3aNF) and to consider them for additional therapy.
PATIENT SUMMARY: Subclassification of extraprostatic extension (EPE) with the Epstein criteria improves correlation with biochemical recurrence-free survival. Prostate cancer-specific survival and overall survival in men with isolated EPE (pT3a) are excellent and are not significantly different between pT3aF and pT3aNF.
Written by:
Jeong BC, Chalfin HJ, Lee SB, Feng Z, Epstein JI, Trock BJ, Partin AW, Humphreys E, Walsh PC, Han M. Are you the author?
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Urology, Seoul National University Boramae Hospital, Seoul, Korea; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Reference: Eur Urol. 2014 Jun 23. pii: S0302-2838(14)00536-3.
doi: 10.1016/j.eururo.2014.06.015
PubMed Abstract
PMID: 24968968
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