1120 IMPACT OF DIFFERENT DEFINITIONS OF HIGH RISK PROSTATE CANCER ON MORTALITY AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 20121120 IMPACT OF DIFFERENT DEFINITIONS OF HIGH RISK PROSTATE CANCER ON MORTALITY AFTER RADICAL PROSTATECTOMY Kenneth Nepple, Gundarshan Sandhu, Dorina Kallogjeri, Robert Grubb, Seth Strope, Eric Klein, Andrew Stephenson, and Adam Kibel Kenneth NeppleKenneth Nepple St. Louis, MO More articles by this author , Gundarshan SandhuGundarshan Sandhu St. Louis, MO More articles by this author , Dorina KallogjeriDorina Kallogjeri St. Louis, MO More articles by this author , Robert GrubbRobert Grubb St. Louis, MO More articles by this author , Seth StropeSeth Strope St. Louis, MO More articles by this author , Eric KleinEric Klein Cleveland, OH More articles by this author , Andrew StephensonAndrew Stephenson Cleveland, OH More articles by this author , and Adam KibelAdam Kibel Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiple definitions of high risk prostate cancer exist. Studies have primarily correlated these definitions with biochemical recurrence and not with prostate cancer specific mortality (PCSM) and overall mortality (OM). METHODS The study population included 6477 men treated with radical prostatectomy between 1995-2005 and followed for a median of 67 months. We applied seven previously described high risk definitions and evaluated their ability to predict mortality. High risk definitions used were: 1) preoperative PSA≥20ng/ml, 2) biopsy Gleason score 8-10, 3) clinical stage ≥ T2c, 4) clinical stage T3, 5) D′Amico definition, 6) National Comprehensive Cancer Network definition, and 7) Kattan nomogram 5-year recurrence-free probability of 50% or less. Survival was evaluated using the Kaplan-Meier method to generate unadjusted prostate cancer survival estimates. To control for the competing risks of age and comorbidity, multivariable Cox proportional hazard regression models were used to estimate the hazard ratio for PCSM and OM in high risk patients compared to low/intermediate risk. RESULTS High risk patients comprised between 0.7% (cT3) and 8.2% (D′Amico) of the study population. The 10-year Kaplan Meier prostate cancer survival estimates varied from 89.7% for PSA≥20 to 69.7% for cT3 (Figure). On multivariable analysis controlling for age and comorbidity, high risk prostate cancer (of all definitions) had an increased risk of PCSM compared to low/intermediate risk with a hazard ratio (HR) ranging from 4.38 for PSA≥20 to 19.97 for cT3 (all p<0.0001). For OM, again controlling for age and comorbidity, high risk patients of all definitions except preoperative PSA≥20 (HR=0.98, p=0.99) were associated with increased risk of OM (HR range: 1.72 for D′Amico, 1.73 for stage≥T2c, 1.75 for Kattan, 1.88 for NCCN, 2.63 for Gleason 8-10, 3.31 for cT3; all p<0.01). CONCLUSIONS In a contemporary cohort of men with high risk prostate cancer treated with radical prostatectomy, the minority of men experienced prostate cancer mortality. However, heterogeneity in outcomes existed based on the definition of high risk used. Clinical stage T3 and high Gleason score (8-10) were most strongly associated with PCSM and OM. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e454 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth Nepple St. Louis, MO More articles by this author Gundarshan Sandhu St. Louis, MO More articles by this author Dorina Kallogjeri St. Louis, MO More articles by this author Robert Grubb St. Louis, MO More articles by this author Seth Strope St. Louis, MO More articles by this author Eric Klein Cleveland, OH More articles by this author Andrew Stephenson Cleveland, OH More articles by this author Adam Kibel Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...