MP64-11 ZONAL DISTRIBUTION OF PROSTATE CANCER IS IMPORTANT PROGNOSTIC FACTOR IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER TREATED ROBOT ASSISTED RADICAL PROSTATECTOMY(RARP)

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V1 Apr 2017MP64-11 ZONAL DISTRIBUTION OF PROSTATE CANCER IS IMPORTANT PROGNOSTIC FACTOR IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER TREATED ROBOT ASSISTED RADICAL PROSTATECTOMY(RARP) Makoto Ohori, Tatsuo Gondo, Yosuke Hirasawa, Takeshi Hashimoto, Yoshihiro Nakagami, Rie Inoue, and Takashi Nagao Makoto OhoriMakoto Ohori More articles by this author , Tatsuo GondoTatsuo Gondo More articles by this author , Yosuke HirasawaYosuke Hirasawa More articles by this author , Takeshi HashimotoTakeshi Hashimoto More articles by this author , Yoshihiro NakagamiYoshihiro Nakagami More articles by this author , Rie InoueRie Inoue More articles by this author , and Takashi NagaoTakashi Nagao More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1984AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Because of the spread of saturation biopsy and MRI guided needle biopsy, we may often see a cancer in transition zone (TZ). To assess whether there is a difference in prognosis in TZ and peripheral zone (PZ) prostate cancer, we studied the patients with clinically localized prostate cancers who had RARP. METHODS We studied retrospectively the clinical and pathological features of 404 consecutive patients with prostate cancer treated with RARP by one surgeon at Tokyo Medical University. We categorized the patients into predominantly PZ cancer, TZ cancer and both TZPZ cancer based on the area of cancer on whole-mount step sections of RARP specimens. Biochemical recurrence (BCR) was evaluated using the Kaplan-Meier method. With a Cox hazard regression analysis, we identified significant preoperative factors that predict BCR, and based on these results, we developed a nomogram to predict the non-BCR at 5 years after RARP. A concordance index was used to assess the value of a nomogram, and a calibration plot was used to compare the predicted values to actual values. RESULTS PZ, TZ and both cancer was identified in 64%, 33% and 3% of the patients, respectively. Non-BCR rates at 2 and 5 year for patients with PZ were 88% and 78%, respectively, compared to 97% and 97% for patients with TZ cancer (p=0.0072). Also, none of 10 patients with both cancer had a BCR. While the frequency of positive surgical margins was similar between PZ and TZ groups (28% for both), the patients with PZ were more likely to have seminal vesicle invasion compared to patients with TZ (10% vs. 1%, p=0.001) and to have >=4+3/4+4 Gleason score (52% vs.40%, p=0.37). In fact, in the absence of seminal vesicle invasion and >=4+3/4+4 Gleason score, non-BCR rate at 3 year was 95% for patients with PZ and 99% for patients with TZ (p=0.40). A Cox hazard regression analysis showed that zonal distribution of cancer (p=0.004) was significantly associated with BCR after controlled with PSA, pathological stage, Gleason score and surgical margins. Based on this analysis, the postoperative momogram to predict non-BCR was constructed with an excellent concordance index of 0.89. The calibration plots also appeared to be good. CONCLUSIONS We concluded that the prognosis of a patient with prostate cancer is significantly more dependent upon the features of cancer in the PZ than in the TZ. Assessment of zonal distribution of cancer is important to gauge prognosis. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e848 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Makoto Ohori More articles by this author Tatsuo Gondo More articles by this author Yosuke Hirasawa More articles by this author Takeshi Hashimoto More articles by this author Yoshihiro Nakagami More articles by this author Rie Inoue More articles by this author Takashi Nagao More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...