title: The relationship between the extent of extraprostatic extension and survival following radical prostatectomy.
abstract: BACKGROUND
  Subclassification of the extent of extraprostatic extension (EPE) in radical prostatectomy (RP) specimens may enhance prognostication for prostate cancer (PCa) patients. Yet optimal criteria for staging, validation within a large cohort, and long-term follow-up are lacking.
  
  
  OBJECTIVE
  To compare biochemical recurrence-free survival (BRFS), PCa-specific survival (PCSS), and overall survival (OS) for focal EPE (pT3aF) and nonfocal EPE (pT3aNF) in a large tertiary-referral center with the Epstein criteria for EPE extent.
  
  
  METHODS
  Between 1982 and 2012, 20 434 men underwent RP, and 15 565 men (76.2%) had available pathologic and survival data. A total of 4216 men with isolated EPE were subclassified into pT3aF (1869 men, 44%) and pT3aNF (2347 men, 56%).
  
  
  METHODS
  Predictors of BRFS, PCSS, and OS were identified with multivariate Cox proportional hazard models. Covariates included age, preoperative prostate-specific antigen, body mass index, surgery year, Gleason score, and surgical margin status.
  
  
  CONCLUSIONS
  With a median follow-up of 9.0 yr (range: 1-27), 314 men died of PCa, with 1300 deaths from any cause. In a multivariate model, pT3aNF compared with pT3aF was an independent predictor of BRFS (hazard ratio [HR]: 1.39; 95% confidence interval [CI], 1.18-1.62; p<0.001), but not of PCSS (HR: 1.38; 95% CI, 0.89-2.11; p=0.146) or OS (HR: 1.13; 95% CI, 0.94-1.36; p=0.197). Ten-year BRFS, PCSS, and OS for pT3aF and pT3aNF were 76% versus 59%, 98% versus 96%, and 95% versus 90%, respectively.
  
  
  CONCLUSIONS
  In a large RP cohort, subclassification of EPE extent with the Epstein criteria improves correlation with BRFS. PCSS and OS in men with isolated EPE (pT3a) are excellent and are not significantly different between pT3aF and pT3aNF. The EPE extent should be subclassified to identify a subgroup of men with a higher risk of recurrence (pT3aNF) and to consider them for additional therapy.
  
  
  RESULTS
  Subclassification of extraprostatic extension (EPE) with the Epstein criteria improves correlation with biochemical recurrence-free survival. Prostate cancer-specific survival and overall survival in men with isolated EPE (pT3a) are excellent and are not significantly different between pT3aF and pT3aNF.
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Byong Chang
authors: BC
authors: Jeong
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Heather J
authors: HJ
authors: Chalfin
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Urology, Seoul National University Boramae Hospital, Seoul, Korea.
authors: Seung Bae
authors: SB
authors: Lee
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Zhaoyong
authors: Z
authors: Feng
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Jonathan I
authors: JI
authors: Epstein
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Bruce J
authors: BJ
authors: Trock
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Alan W
authors: AW
authors: Partin
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Elizabeth
authors: E
authors: Humphreys
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Patrick C
authors: PC
authors: Walsh
authors: Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: mhan1@jhmi.edu.
authors: Misop
authors: M
authors: Han
mesh_terms: D000368:Aged; D015142:Baltimore; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Extraprostatic extension; Prostate cancer; Recurrence; Survival