title: Biochemical failure after radical prostatectomy in intermediate-risk group men increases with the number of risk factors.
abstract: BACKGROUND
  We aimed to determine whether the number and type of risk factors are associated with biochemical recurrence-free survival after radical prostatectomy in men with D'Amico intermediate-risk prostate cancer.
  
  
  METHODS
  Between August 1998 and May 2013, 481 Japanese patients underwent antegrade radical prostatectomy. The relationships between the rate of PSA failure after radical prostatectomy and the number and type of risk factors were examined in the intermediate-risk group.
  
  
  RESULTS
  According to the D'Amico criteria, the low-, intermediate-, and high-risk groups comprised 107, 222, and 152 patients, respectively. The median follow-up period after surgery was 54.1 months. The 5-year PSA failure-free rates in the low-, intermediate-, and high-risk groups were 96.5%, 88.9%, and 72.6%, respectively (P< 0.001). The 5-year PSA failure-free rate in the intermediate-risk group with one, two, and three intermediate risk factors was 94.9%, 88.4%, and 49.0%, respectively (P< 0.001). The difference between the high- and intermediate-risk group with three intermediate risk factors was statistically significant based on the log-rank test (P= 0.039).
  
  
  CONCLUSIONS
  The number of intermediate risk factors is significantly associated with the PSA failure-free survival rate after radical prostatectomy in the intermediate-risk group. Patients classified into the intermediate-risk group based on all three intermediate risk factors are less likely to achieve a complete cure through surgery alone.
authors.affiliation: Department of Urology, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Nobuki
authors.initials: N
authors.lastname: Furubayashi
authors.affiliation: Department of Urology, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Takahito
authors.initials: T
authors.lastname: Negishi
authors.affiliation: Department of Urology, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Iwai
authors.affiliation: Department of Urology, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Nagase
authors.affiliation: Department of Pathology, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Taguchi
authors.affiliation: Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Shimokawa
authors.affiliation: Department of Urology, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Motonobu
authors.initials: M
authors.lastname: Nakamura