Pathological stage: pronostic factors

Abstract

Most of prostatic malignancies are adenocarcinomas. Nomograms using pretreatment clinical or pathological features predict the probability of biochemical or clinical relapse after radical prostatectomy. These predictive tools must not be used in decision making for the anticancer treatment. The accurate pathological stage can only be assessed after examination of the radical prostatectomy specimens. Postoperative nomograms can be also used to predict the probability of survival without progression on the basis of pretreatment PSA level, the Gleason score of the biopsy and prostatectomy samples, the histological grading, the presence or absence of positive surgical margins, involvement of seminal vesicles, capsular penetration and lymph-node metastases. Retrospective studies have confirmed that these pathological post-treatment parameters are risk factors for clinical and biochemical progression. These unfavourable parameters, along with the PSA velocity during the year before radical prostatectomy, predict the risk of local relapse and distant dissemination. Scientific consensus exists for prescribing an adjuvant therapy after the initial local treatment for this population of patients with carcinoma of the prostate who are considered at high risk of progression.