305 EVOLUTION OF THE CLINICAL PRESENTATION OF MEN UNDERGOING RADICAL PROSTATECTOMY FOR HIGH-RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Staging1 Apr 2011305 EVOLUTION OF THE CLINICAL PRESENTATION OF MEN UNDERGOING RADICAL PROSTATECTOMY FOR HIGH-RISK PROSTATE CANCER Phillip Pierorazio, Ashley Ross, Misop Han, Jonathan Epstein, Patrick Walsh, Alan Partin, and Edward Schaeffer Phillip PierorazioPhillip Pierorazio Baltimore, MD More articles by this author , Ashley RossAshley Ross Baltimore, MD More articles by this author , Misop HanMisop Han Baltimore, MD More articles by this author , Jonathan EpsteinJonathan Epstein Baltimore, MD More articles by this author , Patrick WalshPatrick Walsh Baltimore, MD More articles by this author , Alan PartinAlan Partin Baltimore, MD More articles by this author , and Edward SchaefferEdward Schaeffer Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.398AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men with high-risk prostate cancer (HRCaP) present with at least one of the following criteria: advanced clinical stage (>T2b), Gleason grade 8–10, or PSA > 20ng/ml. We hypothesize that over the recent PSA era, men with improved longitudinal screening would present with different HR features and potentially have improved outcomes. METHODS The IRB-approved, Johns Hopkins Radical Prostatectomy (RP) Database was queried from 1992–2010 for men with HRCaP based on D'Amico criteria. Year of surgery was divided into two cohorts: the Early (EPE, 1992–2000) and Contemporary PSA-Era (CPE, 2001–2010). Presenting features and pathological outcomes were evaluated among eras with appropriate comparative tests. Kaplan-Meier method with log-rank test was used to determine biochemical-free (BFS), metastases-free (MFS) and cancer-specific survival (CSS). RESULTS 1,084 men who underwent RP were identified with HRCaP from 1992–2010; 428 (39.5%) in the EPE, 656 (60.5%) in the CPE. In the EPE, 364 (85.1%) presented with a single HR feature; of those, 210 (57.7%) had an elevated PSA, 152 (41.8%) had Gleason 8–10 on biopsy and 2 (0.6%) were >cT2b. In the CPE, 606 (92.5%) presented with a single HR feature (p<0.001); of those, 144 (23.8%) presented with an elevated PSA, 460 (75.9%) presented with Gleason 8–10 and 2 (0.3%) were >cT2b (p<0.001). For men with HRCaP, 10-year BFS was 35.1% and 32.7% in the EPE and CPE respectively (p=0.4); 10-year MFS was 71.5% and 91.4% (p=0.07); 10-year CSS was 79.8% and 80.6% (p=0.6). In the EPE, 10-year BFS was 38.2% vs 18.9% for men with 1 (n=364) and >1 (n=64) HR feature respectively (p=0.003); 10-year MFS was 74.7% and 54.2% (p=0.03); 10-year CSS was 81.7% and 70.3% (p=0.004). In the CPE, 10-year BFS was 36.1% for men with 1 HR feature (n=606); all men with >1 HR feature (n=49) experienced biochemical recurrence prior to 7 years (p=0.002). 10-year MFS in the CPE was 94.0% and 66.5% for men with 1 and >1 HR feature respectively (p=0.002); 10-year CSS was 94.4% and 34.4% (p=0.008). CONCLUSIONS Over the PSA-era, an increasing percentage of men with HRCaP were categorized as HR based on biopsy Gleason sum 8–10, possibly reflecting the earlier detection high-grade lesions or changes in prostate cancer grading. Nevertheless, BFS, MFS and CSS are stable over the PSA-era for men with HRCaP. The accumulation of multiple HR features increases the risk of biochemical recurrence, development of metastases and death from prostate cancer. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e124 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Pierorazio Baltimore, MD More articles by this author Ashley Ross Baltimore, MD More articles by this author Misop Han Baltimore, MD More articles by this author Jonathan Epstein Baltimore, MD More articles by this author Patrick Walsh Baltimore, MD More articles by this author Alan Partin Baltimore, MD More articles by this author Edward Schaeffer Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...