title: Improved decision making in intermediate-risk prostate cancer: a multicenter study on pathologic and oncologic outcomes after radical prostatectomy.
abstract: BACKGROUND
  Prognoses for intermediate-risk prostate cancer (PCa) remain heterogeneous. Improved substratification could optimize treatment and monitoring strategies. The objective was to validate this subclassification in a radical prostatectomy (RP) series.
  
  
  METHODS
  Between 2000 and 2011, 4038 patients who underwent RP for intermediate-risk PCa in seven French academic centers were included. Unfavorable intermediate-risk (UIR) PCa was defined as having a primary Gleason score of 4, ≥50% positive biopsy cores (PPBC), or more than one D'Amico intermediate-risk factor (i.e., cT2b, PSA 10-20, or Gleason score 7). Remaining PCa cases were classified as favorable. Main endpoints were pathologic results (pT stage, final Gleason score, surgical margin status), and oncologic outcomes were assessed according to PSA recurrence-free survival (PSA-RFS). Univariate and multivariate analyses were performed using the log-rank test and the Cox proportional hazards model.
  
  
  RESULTS
  Median follow-up was 48 months (95% CI = [45-49]). Patients with UIR had worse PSA-RFS (68.17 vs. 81.98% at 4 years, HR = 1.97, 95% CI = [1.71; 2.27], p < 0.0001) compared to those with a favorable disease. The need for adjuvant therapy was significantly greater for UIR patients (43.5 vs. 29.2%, p < 0.0001). In multivariate analysis, primary Gleason score of 4 (HR = 1.81, 95% CI = [1.55; 2.12], p < 0.0001) and PPBC ≥ 50% (HR = 1.26, 95% CI = [1.02; 1.56], p = 0.0286) were significant preoperative predictors for worse PSA-RFS.
  
  
  CONCLUSIONS
  This study highlights the heterogeneity of NCCN intermediate-risk patients and validates (in a large RP cohort) the previously proposed subclassification for this group. This classification can significantly predict both pathologic and oncologic outcomes. This easy-to-use stratification could help physicians' decision making. Prospective study and new tools as genomic tests and novel molecular-based approaches can improve this stratification in the future for patient counseling.
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France. jbbeauval@gmail.com.|Institut Claudius Regaud, IUCT-O, 31059, Toulouse, France. jbbeauval@gmail.com.
authors.forename: Jean Baptiste
authors.identifier: http://orcid.org/0000-0002-1532-015X
authors.initials: JB
authors.lastname: Beauval
authors.affiliation: Department of Urology, Clinique St Jean du Languedoc, Toulouse, France.|Institut Claudius Regaud, IUCT-O, 31059, Toulouse, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.affiliation: Institut Claudius Regaud, IUCT-O, 31059, Toulouse, France.
authors.forename: Bastien
authors.initials: B
authors.lastname: Cabarrou
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France.|Institut Claudius Regaud, IUCT-O, 31059, Toulouse, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Lille, Lille, France.
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Gas
authors.affiliation: Department of Urology, Institut Mutualiste Monsouris, Paris-Descartes University, Paris, France.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Goujon
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Lille, Lille, France.
authors.forename: Gautier
authors.initials: G
authors.lastname: Marcq
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Rennes, Rennes, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Rennes, Rennes, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Vincendeau
authors.affiliation: Department of Urology, Institut Mutualiste Monsouris, Paris-Descartes University, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.affiliation: Department of Urology, Andrology and Renal Transplantation Hôpital Saint-Louis, Paris-7 Denis Diderot University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mongiat-Artus
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Mondor, Créteil, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France.|Institut Claudius Regaud, IUCT-O, 31059, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.affiliation: Department of Urology and Renal transplantation, HEGP, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Méjean
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU Mondor, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: de La Taille
authors.affiliation: Department of Urology, Andrology and Renal Transplantation, CHU La Pitié Salpétrière, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: Department of Urology, Institut Mutualiste Monsouris, Paris-Descartes University, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Rozet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D000066491:Clinical Decision-Making; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Biochemical recurrence-free survival; Intermediate risk; Prostate cancer; Radical prostatectomy; Risk factors; Stratification