title: [Metastatic progression, cancer-specific mortality and need for secondary treatments in patients with clinically high-risk prostate cancer treated initially with radical prostatectomy].
abstract: OBJECTIVE
  To determine our results in high risk (HR) prostate cancer (PCa) patients treated with radical prostatectomy (RP) and to establish preoperative prognosis factors.
  
  
  METHODS
  Retrospective study of 925 RP. Mean follow-up for the HR group was 89.8+/-53.6 months. Following NCCN criteria, we operated 210 (22.7%) HR and 715 (77.3%) low/intermediate risk patients. End point was metastatic progression. Kaplan-Meier method for survival comparison among groups and Cox regression model for multivariate analysis of preoperative prognostic factors were used.
  
  
  RESULTS
  Revised period; 1986-2007. Fifty-four patients (25.7%) were free of disease and 8 patients (3.8%) died for other causes free of disease. Disease progressed in 148 patients (70.5%); death due to tumour progression occurred in 42 cases (20%) and due to other causes in 25 patients (11.9%). Seventy-nine patients in HR group (38%) vs 549 low/intermediate risk group (78.5%) did not deserve further treatments (p<0.001). The uni and multivariate analysis for metastatic progression showed both Gleason score at biopsy (RR=1.922; 95% CI 1.106-3.341, p=0.020) and clinical stage (RR=2.290; 95% CI 1.269-4.133, p=0.006) showed independent prognostic value for metastatic progression, but not PSA.
  
  
  CONCLUSIONS
  A HR patient can be cured in a third of the cases and will need multimodal treatments in more than half of the times. We prompt surgery in a young healthy patient with a resectable tumour, mainly if just one bad prognostic factor is present and defiantly if this is just PSA elevation.
authors.affiliation: Instituto Valenciano de Oncología, España. jrubio@fivo.org
authors.forename: J
authors.initials: J
authors.lastname: Rubio-Briones
authors.forename: I
authors.initials: I
authors.lastname: Iborra
authors.forename: M
authors.initials: M
authors.lastname: Trassierra
authors.forename: A
authors.initials: A
authors.lastname: Collado
authors.forename: J
authors.initials: J
authors.lastname: Casanova
authors.forename: A
authors.initials: A
authors.lastname: Gómez-Ferrer
authors.forename: J V
authors.initials: JV
authors.lastname: Ricós
authors.forename: J L
authors.initials: JL
authors.lastname: Monrós
authors.forename: R
authors.initials: R
authors.lastname: Dumont
authors.forename: E
authors.initials: E
authors.lastname: Solsona
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure