Controversial predictors of biochemical recurrence after radical prostatectomy: a study from a Latin American (Brazilian) Institution

Marcelo R Noronha,Leonardo O Reis,Luciana R Meirelles,Athanase Billis,Luis A Magna,Maisa M Q Quintal

doi:10.1590/s1677-5538.ibju.2013.06.03

Abstract

To analyze controversial clinicopathologic predictors of biochemical recurrence after surgery: age, race, tumor extent on surgical specimen, tumor extent on needle biopsy, Gleason score 3 + 4 vs 4 + 3, and amount of extent of extraprostatic extension and positive surgical margins. The needle biopsies and the correspondent surgical specimens were analyzed from 400 patients. Time to recurrence was analyzed with the Kaplan-Meier curves and risk of shorter time to recurrence using Cox univariate and multivariate analysis. Except for age, race, maximum percentage of cancer per core, and number of cores with cancer, all other variables studied were significantly predictive of time to biochemical recurrence using the Kaplan-Meier curves. In univariate analysis, except for focal extraprostatic extension, age, race, focal positive surgical margins, and maximum extent and percentage of cancer per core, all other variables were significantly predictive of shorter time to recurrence. On multivariate analysis, diffuse positive surgical margins and preoperative PSA were independent predictors. Young patients and non-whites were not significantly associated with time to biochemical recurrence. The time consuming tumor extent evaluation in surgical specimens seems not to add additional information to other well established predictive findings. The higher predictive value of Gleason score 4 + 3 = 7 vs 3 + 4 = 7 discloses the importance of grade 4 as the predominant pattern. Extent and not simply presence or absent of extraprostatic extension should be informed. Most tumor extent evaluations on needle biopsies are predictive of time to biochemical recurrence, however, maximum percentage of cancer in all cores was the strongest predictor.

Highlights

While the overall survival of surgically treated prostate cancer patients remains excellent, nearly30% of patients treated definitively will have biochemical recurrence (BR), defined as prostate-specific antigen (PSA) ≥ 0.2 ng/ml according to recommendation of the American Urological Association [1].ibju | Controversial predictors of biochemical recurrence after radical prostatectomyThere are well established clinical and pathological predictors of BR after radical prostatectomy (RP), including preoperative serum PSA, pathological tumor stage, Gleason histological grade, and positive surgical margins [2]
We studied the influence of race in regard to biochemical recurrence after radical prostatectomy
Table-2 shows the Kaplan-Meier product-limit analysis for to biochemical recurrence (TBR) following RP according to several clinicopathologic characteristics

Summary

Introduction

While the overall survival of surgically treated prostate cancer patients remains excellent, nearly30% of patients treated definitively will have biochemical recurrence (BR), defined as prostate-specific antigen (PSA) ≥ 0.2 ng/ml according to recommendation of the American Urological Association [1].ibju | Controversial predictors of biochemical recurrence after radical prostatectomyThere are well established clinical and pathological predictors of BR after radical prostatectomy (RP), including preoperative serum PSA, pathological tumor stage, Gleason histological grade, and positive surgical margins [2]. While the overall survival of surgically treated prostate cancer patients remains excellent, nearly. 30% of patients treated definitively will have biochemical recurrence (BR), defined as prostate-specific antigen (PSA) ≥ 0.2 ng/ml according to recommendation of the American Urological Association [1]. Ibju | Controversial predictors of biochemical recurrence after radical prostatectomy. The influence of age in the biological aggressiveness of prostate cancer is controversial [3,4,5,6]. Prostate cancer may be biologically more aggressive among Black men though controversial [7,8,9,10,11]. We studied the influence of race in regard to biochemical recurrence after radical prostatectomy

Methods

Results

Conclusion