title: Adverse Features and Competing Risk Mortality in Patients With High-Risk Prostate Cancer.
abstract: To assess survival and competing causes of mortality in prostate cancer (PCa) patients referred to radical prostatectomy through a combination of unfavorable characteristics.
  
  
  
  We evaluated 615 PCa patients referred to radical prostatectomy and pelvic lymph node dissection at single tertiary-care center with at least one adverse feature (AF): preoperative prostate-specific antigen ≥ 20 ng/mL, pathologic Gleason score 8 to 10, and no organ-confined disease at final pathology (seminal vesicle involvement, positive surgical margins, and/or lymph node invasion). Kaplan-Meier analyses were used to assess cancer-specific mortality (CSM)-free survival rates by stratifying patients into 3 risk categories according to the number of AFs (namely, 1, 2, and 3 AFs). Multivariable competing risk Cox regression analyses were used to assess CSM and other cause of mortality.
  
  
  
  Significant differences were found in terms of preoperative and pathologic tumor characteristics, adjuvant therapies, and biochemical recurrence (BCR). Men with 1 AF had higher CSM-free survival estimates compared to those with 2 and 3 AFs (92.8% vs. 84.2% vs. 27.7% at 10 years' follow-up, P < .001). Moreover, the presence of 3 AFs (hazard ratio [HR], 2.96), postoperative adjuvant treatment status (HR, 2.44), and time to BCR (HR, 0.96) were all independent predictors of CSM (P ≤ .04). Age at surgery and time to BCR were the only independent predictors of other causes of mortality (P ≤ .0009).
  
  
  
  The risk group stratification according to the number of AFs could help physicians to accurately predict oncologic outcomes and to select PCa patients for the most appropriate postoperative strategies.
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Vagnoni
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bianchi
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Electronic address: mark.borghesi1@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Cristian Vincenzo
authors.initials: CV
authors.lastname: Pultrone
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Hussam
authors.initials: H
authors.lastname: Dababneh
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chessa
authors.affiliation: Department of Urology, Abano Hospital, Padova, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Manna
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Rizzi
authors.affiliation: Department of Nephrology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Porreca
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.affiliation: Department of Urology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
mesh_terms: D000368:Aged; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010388:Pelvis; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000601:surgery; D016019:Survival Analysis
chemical_list: D017430:Prostate-Specific Antigen
keywords: Competing causes of mortality; Prognosis; Radical prostatectomy; Risk category; Survival