title: Natural history of surgically treated high-risk prostate cancer.
abstract: BACKGROUND
  No data exist on the patterns of biochemical recurrence (BCR) and their effect on survival in patients with high-risk prostate cancer (PCa) treated with surgery. The aim of our investigation was to evaluate the natural history of PCa in patients treated with radical prostatectomy (RP) alone.
  
  
  METHODS
  Overall, 2,065 patients with high-risk PCa treated with RP at 7 tertiary referral centers between 1991 and 2011 were identified. First, we calculated the probability of experiencing BCR after surgery. Particularly, we relied on conditional survival estimates for BCR after RP. Competing-risks regression analyses were then used to evaluate the effect of time to BCR on the risk of cancer-specific mortality (CSM).
  
  
  RESULTS
  Median follow-up was 70 months. Overall, the 5-year BCR-free survival rate was 55.2%. Given the BCR-free survivorship at 1, 2, 3, 4, and 5 years, the BCR-free survival rates improved by+7.6%,+4.1%,+4.8%,+3.2%, and+3.7%, respectively. Overall, the 10-year CSM rate was 14.8%. When patients were stratified according to time to BCR, patients experiencing BCR within 36 months from surgery had higher 10-year CSM rates compared with those experiencing late BCR (19.1% vs. 4.4%; P<0.001). At multivariate analyses, time to BCR represented an independent predictor of CSM (P<0.001).
  
  
  CONCLUSIONS
  Increasing time from surgery is associated with a reduction of the risk of subsequent BCR. Additionally, time to BCR represents a predictor of CSM in these patients. These results might help provide clinicians with better follow-up strategies and more aggressive treatments for early BCR.
authors: Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: briganti.alberto@hsr.it.
authors: Alberto
authors: A
authors: Briganti
authors: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN.
authors: Robert Jeffrey
authors: RJ
authors: Karnes
authors: Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Giorgio
authors: G
authors: Gandaglia
authors: Department of Urology, University of Bern, Bern, Switzerland.
authors: Martin
authors: M
authors: Spahn
authors: Department of Urology, University of Turin, Torino, Italy.
authors: Paolo
authors: P
authors: Gontero
authors: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors: Lorenzo
authors: L
authors: Tosco
authors: Department of Urology and Pediatric Urology, University Hospital Wurzburg, Wurzburg, Germany.
authors: Burkhard
authors: B
authors: Kneitz
authors: Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Felix K H
authors: FK
authors: Chun
authors: Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Emanuele
authors: E
authors: Zaffuto
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors: Maxine
authors: M
authors: Sun
authors: Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Markus
authors: M
authors: Graefen
authors: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors: Giansilvio
authors: G
authors: Marchioro
authors: Department of Urology, Community Hospital Karlsruhe, Karlsruhe, Germany.
authors: Detlef
authors: D
authors: Frohneberg
authors: Department of Urology, University of Turin, Torino, Italy.
authors: Simone
authors: S
authors: Giona
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors: Hein
authors: H
authors: Van Poppel
authors: Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Francesco
authors: F
authors: Montorsi
authors: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors: Steven
authors: S
authors: Joniau
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors
chemical_list: D017430:Prostate-Specific Antigen
keywords: Biochemical recurrence; Cancer-specific mortality; Prostate cancer; Radical prostatectomy; Time to biochemical recurrence