title: Radical prostatectomy for high-risk prostate cancer defined by preoperative criteria: oncologic follow-up in national multicenter study in 813 patients and assessment of easy-to-use prognostic substratification.
abstract: OBJECTIVE
  To estimate the effect of predictive factors for oncologic outcomes after radical prostatectomy (RP) for high-risk prostate cancer (PCa).
  
  
  METHODS
  A total of 813 patients underwent RP for high-risk PCa in a national retrospective multi-institutional study. High-risk PCa was defined as follows: prostate-specific antigen (PSA) level>20 ng/mL, Gleason score 8-10, and/or clinical Stage T2c-T4 disease. The preoperative criteria of high-risk PCa were studied in a logistic regression model to assess the correlations with the pathologic findings in the RP specimens. The predictive factors isolated or combined in scores were assessed by Cox multivariate and Kaplan-Meier analyses in predicting PSA failure (recurrence-free survival [RFS]) and overall survival (OS).
  
  
  RESULTS
  The median follow-up was 64 months. Organ-confined disease was reported in 36.5%. The 5-year RFS, metastasis-free survival, and OS rate was 74.1%, 96.1%, and 98.6%, respectively. Each preoperative criteria of high-risk PCa was an independent predictor of PSA failure. The PSA failure risk was increased by 1.5- and 2.8-fold in men with 2 and 3 criteria, respectively. The RFS, but not the OS, was significantly different according to the preoperative score (P<.001). The postoperative score was significantly predictive for RFS and OS (P<.001 and P<.035, respectively). The risk of PSA failure was significantly increased with an increasing postoperative score (2-4.6-fold).
  
  
  CONCLUSIONS
  National data support evidence that RP can result in encouraging midterm oncologic outcomes for the management of high-risk PCa. At 5 years after surgery, 75% of patients remain disease free. Our easy-to-use risk stratification might help clinicians to better predict the clinical and PSA outcomes of high-risk patients after surgery.
authors.affiliation: Department of Urology, APHP, CHU Henri Mondor, Institut National de la Sante et de la Recherche Medicale, Université Paris 12, Créteil, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Alexandra
authors.initials: A
authors.lastname: Masson-Lecomte
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Beauval
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Romain
authors.initials: R
authors.lastname: Bonniol
authors.forename: François
authors.initials: F
authors.lastname: Buge
authors.forename: Saad
authors.initials: S
authors.lastname: Fadli
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Xavier
authors.initials: X
authors.lastname: Rebillard
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gaschignard
authors.forename: Christian
authors.initials: C
authors.lastname: Pfister
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen