MP09-12 FREEDOM FROM BIOCHEMICAL RECURRENCE AND METASTASIS IN MEN WITH VERY HIGH RISK PROSTATE CANCER TREATED AT A TERTIARY CENTER: VALIDATION OF A NEW RISK STRATUM

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2016MP09-12 FREEDOM FROM BIOCHEMICAL RECURRENCE AND METASTASIS IN MEN WITH VERY HIGH RISK PROSTATE CANCER TREATED AT A TERTIARY CENTER: VALIDATION OF A NEW RISK STRATUM Debasish Sundi, Jeffrey Tosoian, Mary Achim, John Davis, Curtis Pettaway, John Ward, Surena Matin, Louis Pisters, Edward Schaeffer, Ashley Ross, and Brian Chapin Debasish SundiDebasish Sundi More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Mary AchimMary Achim More articles by this author , John DavisJohn Davis More articles by this author , Curtis PettawayCurtis Pettaway More articles by this author , John WardJohn Ward More articles by this author , Surena MatinSurena Matin More articles by this author , Louis PistersLouis Pisters More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , Ashley RossAshley Ross More articles by this author , and Brian ChapinBrian Chapin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2299AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Oncologic outcomes of men with high risk prostate cancer (HR PCa) are known to be quite divergent based on the severity of their pre-treatment tumor characteristics. Very high risk (VHR) PCa was originally defined at Johns Hopkins in 2013 and adapted by the NCCN in 2015. In a cohort of men with high risk PCa treated by radical prostatectomy (RP) at MD Anderson Cancer Center (MDACC, 2005-2015), we evaluated the association of VHR PCa with oncologic outcomes. METHODS After institutional review board approval, medical records of HR men treated by RP were abstracted. VHR was defined as 1) presence of primary pattern 5 on biopsy OR 2) presence of more than 4 biopsy cores containing Gleason sum 8-10 OR 3) presence of multiple HR features OR 4) clinical stage T3b-T4, effectively combining previously described Hopkins and NCCN VHR criteria. Hazards for biochemical recurrence (BCR) and metastasis were modeled with Cox proportional hazards models (Stata 13.1). Multivariable analyses adjusted for patient age, treatment year, and receipt of neoadjuvant androgen deprivation therapy. RESULTS Of 658 men with HR PCa treated by RP, 203 were VHR (30.9%). The most common VHR qualification criterion was presence of multiple HR features (152/203, 74.9%). Compared to HR men, VHR patients were more likely to have a positive surgical margin (63.4% vs 30.6%, p<0.001) and pN1 disease (77.2% vs 29.4%, p<0.001). In multivariable models, VHR men were 2-3 fold more likely to sustain biochemical recurrence or metastasis after surgery (Table). CONCLUSIONS In a contemporary cohort of men with HR PCa undergoing RP at a tertiary center, VHR PCa was associated with adverse pathologic and oncologic outcomes, particularly pN1 disease and subsequent metastasis. The distinct clinical outcomes of VHR men may warrant more aggressive or combined modality treatment approaches to maximize cancer free survival. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e98 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Debasish Sundi More articles by this author Jeffrey Tosoian More articles by this author Mary Achim More articles by this author John Davis More articles by this author Curtis Pettaway More articles by this author John Ward More articles by this author Surena Matin More articles by this author Louis Pisters More articles by this author Edward Schaeffer More articles by this author Ashley Ross More articles by this author Brian Chapin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...