Prostate specific antigen outcome based on the extent of extracapsular extension and margin status in patients with seminal vesicle negative prostate carcinoma of Gleason score < or = 7.
BACKGROUND
Early (< or = 2 years) prostate specific antigen (PSA) failure after radical prostatectomy (RP) has been shown to predict for distant failure. After excluding patients with the pathologic predictors of early PSA failure, an analysis of PSA failure free (bNED) survival was performed to identify patients who may benefit from the use of postprostatectomy radiation therapy (RT).


METHODS
Of 1,028 patients treated with RP for clinically localized prostate carcinoma between 1989 and 1999, 862 (84%) had either organ confined (OC), specimen confined (SC), or margin positive disease with negative seminal vesicles (SV) and a prostatectomy Gleason score < or = 7. A Cox regression multivariate analysis was performed in these patients evaluating the ability of the extent of extracapsular extension (ECE) (into but not through the capsule, SC focal ECE, SC established ECE, margin positive) and prostatectomy Gleason score (2-6 vs. 7) to predict time to postoperative PSA failure.


RESULTS
SC focal ECE (P = 0.0017), SC established ECE (P < 0.0001), and margin positive disease (P < 0.0001) were significant predictors of time to postoperative PSA failure, whereas prostatectomy Gleason score and disease extending into but not through the capsule were not. Five-year bNED rates were 90%, 88%, 69%, 45%, and 33% for patients with OC, into but not through capsule, SC focal ECE, SC established ECE, and margin positive prostate carcinoma, respectively.


CONCLUSIONS
Patients with SC ECE or margin positive prostate carcinoma and a prostatectomy Gleason score < or = 7 with no evidence of SV invasion may benefit from adjuvant postoperative RT.
D'Amico
A V
AV
Brigham and Women's Hospital and Dana Farber Cancer Institute, Department of Radiation Oncology, Boston, Massachusetts 02215, USA.
Whittington
R
R
Malkowicz
S B
SB
Schultz
D
D
Tomaszewski
J E
JE
Wein
A
A
D000206:Actuarial Analysis; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012669:Seminal Vesicles / Q000473:pathology*; D015996:Survival Rate; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen