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.


CONCLUSION
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.
['Beauval|Jean-Baptiste|JB|', 'Roumiguié|Mathieu|M|', 'Filleron|Thomas|T|', 'Benoit|Thibaut|T|', 'de la Taille|Alexandre|A|', 'Malavaud|Bernard|B|', 'Salomon|Laurent|L|', 'Soulié|Michel|M|', 'Ploussard|Guillaume|G|']
D000328:Adult D000368:Aged D014408:Biomarkers, Tumor D018572:Disease-Free Survival D005260:Female D005602:France D006801:Humans D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D015995:Prevalence D017430:Prostate-Specific Antigen D011468:Prostatectomy D011471:Prostatic Neoplasms D015203:Reproducibility of Results D012189:Retrospective Studies D018570:Risk Assessment D012680:Sensitivity and Specificity D016896:Treatment Outcome
Radical prostatectomy Risk factors BCR free-survival High risk prostate cancer Stratification