1327 THE PRESENCE OF EXTRAPROSTATIC EXTENSION INCREASES THE RISK OF DEATH FROM PROSTATE CANCER AFTER RADICAL PROSTATECTOMY FOR PATIENTS WITH PT3B DISEASE

Abstract

INTRODUCTION AND OBJECTIVES: Patients with pathologic T3b (seminal vesicle invasion) prostate cancer are at increased risk for disease recurrence and cancer-related mortality following radical prostatectomy (RP). Clinicopathologic features which stratify the risk of disease progression in these patients continue to be defined. We sought to determine the prognostic significance of extraprostatic extension (EPE) in patients with pT3b tumors with regard to the risks of subsequent biochemical recurrence (BCR), systemic progression (SP), and death from prostate cancer. METHODS: We reviewed 16,453 patients who underwent RP without prior therapy at our institution from 1987-2009 to identify patients noted to have pT3bN0 disease. Survival was estimated using the Kaplan Meier method and compared with the log rank test. The association of EPE with outcome was evaluated on Cox multivariate hazards regression models, controlling for Gleason score, preoperative PSA, tumor volume, and surgical margin status. RESULTS: A total of 1,132 patients with pT3b disease at RP were identified. Mean postoperative follow-up was 10.6 years (range 0-23.3). Of these, 693 (61%) also had pathologic evidence of EPE. Men with EPE, compared to those without, had a higher mean preoperative PSA (21.1 ng/ml vs 14.1 ng/ml; p 0.0001) and an increased rate of pathologic Gleason score 8-10 (28.1% vs 16.9%; p 0.0001). Overall, compared to patients without EPE, patients with EPE had an increased risk of BCR (63% vs 53%), SP (22% vs 14%), and death from prostate cancer (14% vs 8%) (p 0.0001 for all). Moreover, on multivariate analysis, the presence of EPE remained associated with significantly increased risks of BCR (HR 1.32, p 0.003), SP (HR 1.56, p 0.01), and death from prostate cancer (HR 1.7, p 0.03). In addition, increased Gleason score and higher tumor volume were significant predictors of death from prostate cancer (HR 2.31, p 0.0001; and HR 1.33, p 0.0006). On the other hand, administration of adjuvant hormonal therapy was associated with significantly lower risks of BCR (HR 0.32, p 0.0001), SP (HR 0.42, p 0.0001), and prostate cancer death (HR 0.49, p 0.009). CONCLUSIONS: The presence of EPE in patients with pT3b prostate cancer is significantly associated with increased risks of BCR, SP, and death from prostate cancer following RP. As the presence of EPE portends poorer outcomes in this patient population, consideration of adjuvant therapy should be given to pT3b patients with this pathologic finding.