Reassessment of the risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer treated using radical prostatectomy.
OBJECTIVE
To assess the risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer patients treated using radical prostatectomy.


METHODS
We retrospectively reviewed the medical records of 1268 men with prostate cancer treated using radical prostatectomy without neoadjuvant therapy. The association between various risk factors and biochemical recurrence was then statistically evaluated. The Kaplan-Meier method, log-rank tests and Cox proportional hazards models were used for statistical analysis.


RESULTS
In the intermediate-risk group, 96 patients (14.5%) experienced biochemical recurrence during a median follow up of 41 months. In the intermediate-risk group, preoperative prostate-specific antigen level, prostate volume and prostate-specific antigen density were significant preoperative risk factors for biochemical recurrence, whereas other factors including age, primary Gleason 4, clinical stage >T2 and percentage of positive biopsies were not. In multivariate analysis, higher preoperative prostate-specific antigen level and density, and a smaller prostate volume were independent risk factors for biochemical recurrence in the intermediate-risk group. Biochemical recurrence-free survival of patients in the intermediate-risk group with a higher prostate-specific antigen level and density (≥15 ng/mL, ≥0.6 ng/mL/cm(3), respectively), and lower prostate volume (≤10 mL) was comparable with that of high-risk group individuals (P = 0.632, 0.494 and 0.961, respectively).


CONCLUSIONS
Preoperative prostate-specific antigen, prostate volume and prostate-specific antigen density are significant risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer patients treated using radical prostatectomy. Using these variables, a subset of the intermediate-risk patients can be identified as having equivalent outcomes to high-risk patients.
Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Shintaro
S
Narita
Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Koji
K
Mitsuzuka
Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Norihiko
N
Tsuchiya
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Takuya
T
Koie
Department of Urology, Miyagi Cancer Center, Natori, Japan.
Sadafumi
S
Kawamura
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Chikara
C
Ohyama
Department of Urology, Miyagi Cancer Center, Natori, Japan.
Tatsuo
T
Tochigi
Department of Medical Sciences and Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan.
Takuhiro
T
Yamaguchi
Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Yoichi
Y
Arai
Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Tomonori
T
Habuchi
D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis
D017430:Prostate-Specific Antigen
D'Amico risk classification; biochemical recurrence; intermediate; prostate cancer; prostate specific antigen