title: Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy.
abstract: 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.
authors.affiliation: 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.
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
authors.affiliation: 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.
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.affiliation: 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.
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.affiliation: 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.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.affiliation: 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.
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.affiliation: 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.
authors.forename: Ofer
authors.initials: O
authors.lastname: Yossepowitch
authors.affiliation: 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.
authors.forename: Hsu
authors.initials: H
authors.lastname: Chao-Yu
authors.affiliation: 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.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.affiliation: 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.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.affiliation: 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.
authors.forename: Alwyn
authors.initials: A
authors.lastname: Reuther
authors.affiliation: 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.
authors.forename: Hein Van
authors.initials: HV
authors.lastname: Poppel
authors.affiliation: 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.
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: 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.
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.affiliation: 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.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: 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