PD63-01 RADICAL PROSTATECTOMY FOR PATIENTS WITH HIGH-RISK, VERY-HIGH RISK, OR METASTATIC PROSTATE CANCER: ONCOLOGIC RESULTS FROM THE MUSIC STATEWIDE COLLABORATIVE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V (PD63)1 Apr 2020PD63-01 RADICAL PROSTATECTOMY FOR PATIENTS WITH HIGH-RISK, VERY-HIGH RISK, OR METASTATIC PROSTATE CANCER: ONCOLOGIC RESULTS FROM THE MUSIC STATEWIDE COLLABORATIVE Brian Lane*, Silvia Mora, Ji Qi, Todd Morgan, Christopher Brede, James Peabody, Arvin George, and for the Michigan Urological Surgery Improvement Collaborative Brian Lane*Brian Lane* More articles by this author , Silvia MoraSilvia Mora More articles by this author , Ji QiJi Qi More articles by this author , Todd MorganTodd Morgan More articles by this author , Christopher BredeChristopher Brede More articles by this author , James PeabodyJames Peabody More articles by this author , Arvin GeorgeArvin George More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000980.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guideline-recommended management of high risk (HR) prostate cancer (PCa) is radical prostatectomy with pelvic lymph node dissection (RP+PLND) or radiation therapy with/without systemic therapy. Increasingly, patients with regional (N1) and distant (M1) metastases are being considered for definitive local therapy. We investigated the oncologic outcomes of surgery for patients categorized as HR, very-high risk (VHR), or with suspected metastatic (N1 and/or M1) PCa at the time of RP. METHODS: The MUSIC registry was queried for all RP from 1/2012 to 12/ 2018. Of the 9208 patients, 2023 patients (22%) were classified as having HR PCa or higher. HR PCa was defined as having PSA≥20 or cT3-4 or biopsy grade group (bGG) 4-5;VHR PCa was defined as having ≥2 HR features, or >4 cores of bGG 4-5, or primary pattern 5. Metastatic PCa was defined as clinical N1 and/or M1 disease. The pre-treatment and oncologic outcomes of the HR, VHR, and metastatic groups were compared. Kaplan-Meier analysis of biochemical recurrence (BCR) and multivariable analyses were performed with significance set at p<0.05. RESULTS: At median follow-up of 20.8 months after RP, overall 3-year BCR-free probability was 66% for HR, 49% for VHR, and 47% for metastatic PCa patients (p<0.001). In multivariable analysis, the highly significant (p<0.001) predictors of BCR included PSA (Hazard Ratio: 3.35 (95%CI:2.32,4.83) for PSA>50, 2.35 (1.87,2.96) for PSA 20-50, and 2.07 (1.71,2.51) for PSA 10-20 vs. PSA<10) and risk group (1.63 (1.22,2.18) for metastatic and 1.45 (1.18,1.77) for VHR vs. HR). bGG 3-5, cT2-T4, and African-American race were significant BCR predictors. CONCLUSIONS: Nearly 25% of RP were performed for HR or higher PCa. Although these patients are clearly at higher risk for BCR and many received additional treatments for PCa, the majority are disease-free 3 years after surgery. RP appears to be an oncologically-sound approach for patients with HR and VHR PCa. Patients with suspicion of N1 or M1 disease that undergo RP appear to have similar oncologic outcomes to non-metastatic VHR patients. The value of local treatment in the setting of confirmed metastatic disease is the focus of ongoing clinical trials, and is best performed in this setting. Source of Funding: Betz Family Endowment for Cancer ResearchBlue Cross Blue Shield of Michigan © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1292-e1292 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Lane* More articles by this author Silvia Mora More articles by this author Ji Qi More articles by this author Todd Morgan More articles by this author Christopher Brede More articles by this author James Peabody More articles by this author Arvin George More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...