Risk-stratified survival rates and predictors of biochemical recurrence after radical prostatectomy in a Nara, Japan, cohort study

Abstract

The aim of this study was to evaluate the oncological outcomes in patients who underwent radical prostatectomy in various risk groups. The subjects were 468 patients with clinically localized or locally advanced adenocarcinoma of the prostate (T1-3N0M0) who underwent retropubic radical prostatectomy with/without neoadjuvant and/or adjuvant therapy at Nara Medical University and its affiliated hospitals between January 1997 and December 2006. All patients were stratified by D'Amico risk classification. The independent predictor of biochemical recurrence was determined in each risk group. Of all 468 patients, 171 patients showed biochemical recurrence during a mean follow-up period of 53months. The 5-year estimated biochemical recurrence-free survival rates in the low, intermediate, and high-risk groups were 77.3, 71.3, and 46.3%, respectively. The multivariate analysis using Cox's proportional hazard model showed that patient age in the low-risk group, seminal vesicle involvement in the intermediate-risk group, and prostate-specific antigen value at diagnosis, surgical Gleason score, percent positive core, and perineural invasion in the high-risk group were independent predictors of biochemical recurrence. The high-risk patients showed a significant higher biochemical recurrence than the low- and intermediate-risk patients. The independent predictor of biochemical recurrence was different in each risk group.