Biochemical recurrence-free survival and pathological outcomes after radical prostatectomy for high-risk prostate cancer.
BACKGROUND
We propose to improve the prognostic assessment after radical prostatectomy (RP) by dividing high-risk prostate cancer (hrPCa) (according to the d'Amico classification) into subgroups combining 1, 2 or 3 criteria of aggressiveness (cT2c-T3a, PSA >20 ng/ml, Gleason score (GS) > 7).


METHODS
Data from 4795 hrPCa patients who underwent RP in two French university hospitals from 1991 to 2013 were analyzed. Subgroups were formed to determine whether an increasing number (1, 2 or 3) of criteria of tumor aggressiveness was associated with poorer oncological results and early biochemical recurrence (BCR) (PSA > 0.2 ng/ml). These results were compared using Fisher's exact test and BCR was compared according to the Kaplan-Meier method.


RESULTS
Eight hundred fifteen patients were treated by RP for hrPCa (8 %). Four hundred eleven patients (79.5 %) presented 1 RF (Risk Factor), 93 (18.0 %) 2 RF and 13 (2.5 %) 3 RF. Lymph node invasion and positive margin rates were 12.4 and 44.1 %, respectively. The prognostic sub-stratification based on these 3 factors was significantly predictive for adverse pathologic features and for oncologic outcomes. BCR free survival was respectively 56.4, 27.06 and 18.46 % for 1RF, 2RF and 3RF (p < 0.0001). However, no predominant negative criterion was found.


CONCLUSIONS
Oncologic results after RP are heterogenous within the hrPCa risk group. Sub-stratification based on three well-defined criteria leads to a better identification of the most aggressive cancers. On the other hand, RP provides both effective cancer control and satisfactory survival rates in patients with only one risk factor.
Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, 1, av J Pouilhès, 31059, Toulouse, France. jbbeauval@gmail.com.
Jean-Baptiste
JB
Beauval
Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, 1, av J Pouilhès, 31059, Toulouse, France.
Mathieu
M
Roumiguié
Institut Claudius Regaud, IUCT-O, Toulouse, F-31059, France.
Thomas
T
Filleron
Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, 1, av J Pouilhès, 31059, Toulouse, France.
Thibaut
T
Benoit
Department of Urology, Andrology and Renal Transplantation, CHU Mondor, Créteil, France.
Alexandre
A
de la Taille
Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, 1, av J Pouilhès, 31059, Toulouse, France.
Bernard
B
Malavaud
Department of Urology, Andrology and Renal Transplantation, CHU Mondor, Créteil, France.
Laurent
L
Salomon
Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, 1, av J Pouilhès, 31059, Toulouse, France.
Michel
M
Soulié
Department of Urology, Clinique St Jean du Languedoc, Toulouse, France.
Guillaume
G
Ploussard
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D018572:Disease-Free Survival; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
BCR free-survival; High risk prostate cancer; Radical prostatectomy; Risk factors; Stratification