title: Clinically high-risk prostate cancer patients comprise a relevant number of cancers with overall favorable tumor characteristics.
abstract: OBJECTIVE
  We hypothesized that a relevant number of patients with clinically high-risk prostate cancer (PCA) indeed harbor overall favorable tumor characteristics (OFTC) (i.e., pT2a-c and Gleason score ≤3 + 4 = 7 and pN0/X) and that in these patients radical prostatectomy (RP) alone is most likely curative.
  
  
  METHODS
  Between June 1, 1997, and October 31, 2011, 2,346 patients with biopsy-detected PCA underwent RP. According to D'Amico, 1,767 patients presented low-/intermediate-risk PCA, and 579 presented high-risk PCA. We compared the incidence of OFTC between low-/intermediate-risk and high-risk patients, and between high-risk patients with different risk factor constellations. Furthermore, overall survival (OS), cancer-specific survival (CSS) and biochemical progression-free survival (BFS) were calculated for low-/intermediate-risk and high-risk patients with and without OFTC.
  
  
  RESULTS
  High-risk patients were less likely to harbor OFTC (17.3 vs. 58.2 %; p < 0.001). That means, however, that nearly one in five patients with clinically high-risk PCA indeed had OFTC. Particularly, the subgroup with PSA >20 ng/ml or cT2c-3 tumor as sole high-risk factor showed a considerable proportion of OFTC in 30.2 and 26.1 % of cases, respectively. While the entire high-risk group had shorter OS, CSS and BFS than the low-/intermediate-risk group, high-risk patients with OFTC had comparably good OS, CSS and BFS as low-/intermediate-risk patients with OFTC.
  
  
  CONCLUSIONS
  Nearly, one in five patients assumed to have high-risk PCA indeed had OFTC. Particularly, patients with PSA >20 ng/ml or cT2c-3 tumor as sole high-risk factor were often misclassified. However, these misclassified patients achieve excellent survival and have a reasonable chance of cure with RP alone.
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany, m-musch@web.de.
authors.forename: M
authors.initials: M
authors.lastname: Musch
authors.forename: J
authors.initials: J
authors.lastname: Pluemer
authors.forename: U
authors.initials: U
authors.lastname: Roggenbuck
authors.forename: V
authors.initials: V
authors.lastname: Klevecka
authors.forename: D
authors.initials: D
authors.lastname: Kroepfl
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D017430:Prostate-Specific Antigen