Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy.
OBJECTIVE
• To investigate the pathological characteristics and the rates of biochemical recurrence (BCR) -free survival after radical prostatectomy (RP) in men with high-risk prostate cancer.


METHODS
• Of 4760 patients treated with RP for prostate cancer at three institutions, 293 patients (6.2%) had clinical stage T3, 269 (5.7%) had a biopsy Gleason sum ≥ 8, 370 (7.8%) had preoperative PSA ≥ 20 ng/mL and 887 (18.6%) were considered high-risk according to the D'Amico classification (clinical stage ≥ T2c or prostate-specific antigen (PSA) ≥ 20 ng/mL or biopsy Gleason sum ≥ 8). • Actuarial BCR-free survival probabilities after RP and the rate of favourable pathology (organ-confined cancer, negative surgical margin and Gleason ≤ 7) were assessed.


RESULTS
• Median follow up was 2.4 years and 1179 (24.8%) patients had follow up beyond 5 years. • The rate of favourable pathology increased in the following order: clinical stage T3 (13.7%), biopsy Gleason ≥ 8 (16.4%), the D'Amico high-risk group (21.4%) and PSA ≥ 20 ng/mL (21.6%). • The 5-year BCR-free survival probabilities were 35.4% for Gleason ≥ 8, 39.8% for PSA ≥ 20 ng/mL, 47.4% for D'Amico high-risk group and 51.6% for clinical stage T3. • Patients with only one risk factor had the most favourable 5-year BCR-free survival (50.3%), relative to patients with two or more risk factors (27.5%)


CONCLUSIONS
• Men with clinically localized high-risk prostate cancer do not have a uniformly poor prognosis after RP. • The rate of favourable pathology and of BCR-free survival may vary substantially, depending on the definition used. • RP should be considered a valid treatment modality for high-risk prostate cancer patients, as many can be surgically down-staged.
Walz
Jochen
J
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Joniau
Steven
S
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Chun
Felix K
FK
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Isbarn
Hendrik
H
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Jeldres
Claudio
C
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Yossepowitch
Ofer
O
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Chao-Yu
Hsu
H
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Klein
Eric A
EA
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Scardino
Peter T
PT
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Reuther
Alwyn
A
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Poppel
Hein Van
HV
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Graefen
Markus
M
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Huland
Hartwig
H
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Karakiewicz
Pierre I
PI
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, CanadaDepartment of Urology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Urology, University Hospital Katholieke Universiteit, Leuven, BelgiumDepartment of UrologyMartini Clinic, Prostate Cancer Centre, University Medical Centre Eppendorf, Hamburg, GermanySidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NYGlickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D017211:Treatment Failure