MP57-20 PATTERNS OF CLINICAL RECURRENCE AND PREDICTORS OF SYSTEMIC PROGRESSION OF PROSTATE CANCER PATIENTS WITH PSA PERSISTENCE AFTER RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2016MP57-20 PATTERNS OF CLINICAL RECURRENCE AND PREDICTORS OF SYSTEMIC PROGRESSION OF PROSTATE CANCER PATIENTS WITH PSA PERSISTENCE AFTER RADICAL PROSTATECTOMY Giorgio Gandaglia, Nicola Fossati, Paolo Dell'Oglio, Rocco Damiano, Marco Bianchi, Marta Picozzi, Elena Farina, Vito Cucchiara, Roberto Bertini, Federico Dehò, Francesco Montorsi, and Alberto Briganti Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Rocco DamianoRocco Damiano More articles by this author , Marco BianchiMarco Bianchi More articles by this author , Marta PicozziMarta Picozzi More articles by this author , Elena FarinaElena Farina More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.674AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies demonstrated that Prostate Cancer (PCa) patients who experience PSA persistence after radical prostatectomy (RP) are at increased risk of clinical progression and death. We hypothesized that the outcomes of patients with PSA persistence after RP are heterogeneous and that not all patients would ultimately experience adverse outcomes METHODS A total of 170 patients with clinically localized PCa undergoing radical prostatectomy (RP) at a single referral tertiary center between 1994 and 2014 were identified. All patients included in the study had a PSA≥0.1 ng/ml 6 weeks after surgery. Biochemical recurrence (BCR) was defined as two consecutive PSA raises≥0.2ng/ml. Clinical recurrence (CR) was defined as positive imaging during follow-up after the onset of BCR. Patients were stratified according to the site of CR in those with local (prostate bed and/or pelvic lymph nodes relapse) and systemic recurrence (retroperitoneal lymph nodes and/or skeletal and/or visceral relapse). Kaplan-Meier analyses assessed time to BCR and CR. Multivariable Cox regression analyses assessed the predictors of systemic recurrence RESULTS Median age at surgery was 64.8 years. Overall, 22 (12.9%), 64 (37.6%), and 84 (49.4%) patients had pathologic Gleason score ≤6, 7, and ≥8, respectively. Overall, 88 (51.8%) patients had positive surgical margins and 48 (28.2%), 39 (22.9%), 83 (48.8%), and 96 (56.5%) patients had pT2, pT3a, pT3b/4, and pN1 disease, respectively. The median number of positive nodes was 3. Median follow-up was 63 months. Overall, 110 and 41 patients experienced BCR and CR, respectively. Among patients experiencing CR, 13 (31.7%) vs. 28 (68.3%) had local vs. systemic recurrence. Overall, the 5-year BCR- and CR-free survival rates were 30.3% and 60.2%. At multivariable analyses, lymph node invasion (Hazard Ratio [HR]: 17.6; 95% Confidence Interval [CI]: 1.88-50.6; P=0.01) and the number of positive nodes (HR: 1.04; 95% CI: 1.00-1.05; P=0.03) represented the only independent predictors of experiencing systemic recurrence CONCLUSIONS The oncologic outcomes of patients with PSA persistence after surgery are not invariably poor. At 5-year follow-up, more than 60% of them are free from clinical recurrence. Patients with node-positive disease and with a higher number of positive nodes are at increased risk of experiencing systemic recurrence. These men should receive additional cancer therapies in a timely fashion © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e760-e761 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Giorgio Gandaglia More articles by this author Nicola Fossati More articles by this author Paolo Dell'Oglio More articles by this author Rocco Damiano More articles by this author Marco Bianchi More articles by this author Marta Picozzi More articles by this author Elena Farina More articles by this author Vito Cucchiara More articles by this author Roberto Bertini More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...