title: Disease-specific outcomes of radical prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time.
abstract: BACKGROUND
  Prostate cancer is the most common male malignancy and a mayor cause of mortality in the western world. The impact of clinicopathological variables on disease related outcomes have mainly been reported from a few large US series, most of them not reporting on perineural infiltration. We therefore wanted to investigate relevant cancer outcomes in patients undergoing radical prostatectomy in two Norwegian health regions with an emphasis on the impact of perineural infiltration (PNI) and prostate specific antigen- doubling time (PSA-DT).
  
  
  METHODS
  We conducted a retrospective analysis of 535 prostatectomy patients at three hospitals between 1995 and 2005 estimating biochemical failure- (BFFS), clinical failure- (CFFS) and prostate cancer death-free survival (PCDFS) with the Kaplan-Meier method. We investigated clinicopathological factors influencing risk of events using cox proportional hazard regression.
  
  
  RESULTS
  After a median follow-up of 89 months, 170 patients (32%) experienced biochemical failure (BF), 36 (7%) experienced clinical failure and 15 (3%) had died of prostate cancer. pT-Stage (p = 0.001), preoperative PSA (p = 0.047), Gleason Score (p = 0.032), non-apical positive surgical margins (PSM) (p = 0.003) and apical PSM (p = 0.031) were all independently associated to BFFS. Gleason score (p = 0.019), PNI (p = 0.012) and non-apical PSM (p = 0.002) were all independently associated to CFFS while only PNI (P = 0.047) and subgroups of Gleason score were independently associated to PCDFS. After BF, patients with a shorter PSA-DT had independent and significant worse event-free survivals than patients with PSA-DT > 15 months (PSA-DT = 3-9 months, CFFS HR = 6.44, p < 0.001, PCDFS HR = 13.7, p = 0.020; PSA-DT < 3 months, CFFS HR = 11.2, p < 0.001, PCDFS HR = 27.5, p = 0.006).
  
  
  CONCLUSIONS
  After prostatectomy, CFFS and PCDFS are variable, but both are strongly associated to Gleason score and PNI. In patients with BF, PSA-DT was most strongly associated to CF and PCD. Our study adds weight to the importance of PSA-DT and re-launches PNI as a strong prognosticator for clinically relevant endpoints.
authors.affiliation: Institute of Clinical Medicine, The Arctic University of Norway, Tromso, Norway. sigve.andersen@uit.no.
authors.forename: Sigve
authors.initials: S
authors.lastname: Andersen
authors.forename: Elin
authors.initials: E
authors.lastname: Richardsen
authors.forename: Yngve
authors.initials: Y
authors.lastname: Nordby
authors.forename: Nora
authors.initials: N
authors.lastname: Ness
authors.forename: Oystein
authors.initials: O
authors.lastname: Størkersen
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Shibli
authors.forename: Tom
authors.initials: T
authors.lastname: Donnem
authors.forename: Helena
authors.initials: H
authors.lastname: Bertilsson
authors.forename: Lill-Tove
authors.initials: LT
authors.lastname: Busund
authors.forename: Anders
authors.initials: A
authors.lastname: Angelsen
authors.forename: Roy M
authors.initials: RM
authors.lastname: Bremnes
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D010524:Peripheral Nervous System Neoplasms / Q000401:mortality*; D011182:Postoperative Care / Q000706:statistics & numerical data; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen