1492 BIOCHEMICAL PROGRESSION FREE SURVIVAL AFTER RADICAL PROSTATECTOMY IN MEN WITH HIGH-RISK CLINICALLY LOCALISED PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized (VII)1 Apr 20131492 BIOCHEMICAL PROGRESSION FREE SURVIVAL AFTER RADICAL PROSTATECTOMY IN MEN WITH HIGH-RISK CLINICALLY LOCALISED PROSTATE CANCER Joseph Ischia, Larry Goldenberg, Alan So, Peter Black, and Martin Gleave Joseph IschiaJoseph Ischia Vancouver, Canada More articles by this author , Larry GoldenbergLarry Goldenberg Vancouver, Canada More articles by this author , Alan SoAlan So Vancouver, Canada More articles by this author , Peter BlackPeter Black Vancouver, Canada More articles by this author , and Martin GleaveMartin Gleave Vancouver, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2971AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Less than 20% of men with ≥cT3 or very high-risk (by CAPRA score 7-10) prostate cancer receive radical prostatectomy (RP) as their primary treatment due to concerns about the lack of efficacy of surgery as monotherapy and the risk of morbidity. The objective of this study is to report on the biochemical progression-free outcomes of radical prostatectomy in men with high-risk localized prostate cancer, particularly those with ≥cT3 or very high (CAPRA based)-risk. METHODS 565 patients were identified on a prospectively collected database of radical prostatectomy for high-risk clinically localized prostate cancer at a single institution. High risk prostate cancer was defined as having 1 or more of 3 adverse pre-operative parameters: prostate-specific antigen (PSA) >20 ng/mL, biopsy Gleason score 8 to 10 and clinical stage ≥T3. PSA recurrence was defined as a PSA >0.2 ng/mL or initiation of any salvage therapy. Cox regression analysis was used to test for independent predictors of biochemical progression-free survival (bPFS). RESULTS Median age was 63.8 years (45.7-79.6). Median follow-up was 2.4 years (range 0.1-20.2 years). Pre-operatively, 25.8% of men had a PSA>20 ng/mL; 72.6% had a biopsy Gleason score 8 to 10; and 22.5% had clinical stage ≥T3. Moreover, 80% of patients had a single baseline risk factor, 16.8% had 2 risk factors and 3.2% had all 3 risk factors. Neoadjuvant therapy was administered to 279 patients (49%) and adjuvant therapy to 97 (17%); while 230 men (41%) received RP monotherapy. The overall 5 and 10-year bPFS were 60% and 50%, respectively. The 5-year bPFS was 66% for 1 risk factor and 47% for 2 factors; no man with 3 risk factors survived past 2.8 years without a recurrence. The 5-year bPFS for PSA>20 ng/mL, Gleason 8-10, and ≥cT3 were 57%, 56%, and 52% respectively. The 5-yr bPFS for men with very high-risk prostate cancer (CAPRA score 7-10) was 48%. On multivariate analysis, only biopsy Gleason score and the number of risk factors were independent predictors of bPFS. CONCLUSIONS Radical prostatectomy should be considered a primary treatment option in men with high-risk localized prostate cancer. Around half of men with very high-risk disease will be cured with radical prostatectomy as the central (and often only) component of their primary treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e611 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Ischia Vancouver, Canada More articles by this author Larry Goldenberg Vancouver, Canada More articles by this author Alan So Vancouver, Canada More articles by this author Peter Black Vancouver, Canada More articles by this author Martin Gleave Vancouver, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...