[Risk factors for biochemical recurrence after radical prostatectomy in patients with clinically localized prostate cancer. Implications of adjuvant treatment].
To evaluate the pathological variables predictive of biochemical recurrence after radical prostatectomy and their implications for decision making in the adjuvant setting.


METHODS
684 patients with localized prostate cancer who were treated with radical prostatectomy between 1996 and 2007. Before surgery they were classified according to D'Amico risk groups for recurrence. Following prostatectomy the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins, perineural invasion and percentage of involvement in the piece. Univariate analysis was performed and subsequently adjusted using a Cox proportional hazards model (method enter).


RESULTS
The median follow up of the series was 61 months. 29.1% of patients had biochemical recurrence. Overall mortality of the series was 4.9% and cancer-specific mortality 1.2%. In univariate analysis the Gleason score of surgical specimens, capsular invasion, perineural invasion, involvement of surgical margins, pathological stage and percentage of involvement of the piece had statistically significant (p <0.001) relation with biochemical recurrence. In multivariate analysis, a Gleason score ≥ 8 in the surgical specimen (HR = 3.08), existence of affected surgical margins (HR = 2.98), pT3 stage (HR = 1.61) and involvement of more than 50% of the piece by cancer (HR = 3.39) were identified as independent predictors of biochemical recurrence. Stratifying by independent predictors of biochemical recurrence (pT, Gleason score and margin), patients with at least 2 of these factors had an incidence of biochemical recurrence at 5 years exceeding 50%.


CONCLUSIONS
Patients who have a Gleason score ≥ 8, positive margins, pT3 tumour or a percentage of >50% after prostatectomy have an increased risk of biochemical recurrence. Patients with at least 2 predictors of relapse have a probability of recurrence over 50% in the first 5 years of recurrence and should therefore be candidates for adjuvant radiotherapy.
Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España. nissangaviota@gmail.com
Eva V Paños
EV
Fagundo
Felipe Herranz
FH
Amo
Esther López
EL
López
Javier Piñero
JP
Sánchez
Gema del Pozo
Gdel P
Jiménez
Juan Aragón
JA
Chamizo
José María Díez
JM
Cordero
María Elena Rodríguez
ME
Fernández
Carlos Hernández
CH
Fernández
D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology* / Q000601:surgery*; D012307:Risk Factors
D017430:Prostate-Specific Antigen