Predictor Of Biochemical Progression-free Survival Research Articles

The Correlation Between Platelet Count and Survival in Prostate Cancer.

PurposeA number of studies have confirmed that elevated platelet count accompanying various solid tumours is associated with worse survival. However, only meagre data are available on the relationship between thrombocytosis and survival in prostate cancer.MethodsWe conducted a retrospective analysis on clinical-pathological data accumulated from 316 patients during on average 51 months of follow-up after laparoscopic prostatectomy performed for prostate cancer. We analyzed the relationship between platelet count, risk factors, prostate-specific antigen (PSA) and cancer stage with use the Tumor, Node, Metastase system (TNM), as well as surgical margin, and prognosis.ResultsThrombocytosis occurred in only one out of the 316 patients. The multivariate Cox proportional hazard model showed that preoperative PSA, risk group, preoperative haemoglobin level, and surgical margin status were significant, independent predictors of biochemical progression-free survival. By contrast, age at diagnosis and thrombocytosis had no such predictive value.ConclusionWe could not demonstrate an association between elevated platelet count and worse survival in our study population of patients with prostate cancer.

Salvage Cryoablation for Radiorecurrent Prostate Cancer: Initial Experience at a Regional Health Care System.

Local recurrence after radiotherapy for prostate cancer remains challenging to treat effectively. Although oncologic control is highest with salvage prostatectomy, the procedure is associated with substantial morbidity. To identify factors associated with successful salvage cryoablation for radiorecurrent prostate cancer. We retrospectively reviewed the medical records of patients who underwent salvage cryoablation at our institution between 2005 and 2015. All patients had biopsy-proven local recurrence after radiotherapy. Patients with seminal vesicle invasion or metastases were excluded. Complete follow-up was obtained for all patients. Primary study endpoint was biochemical progression-free survival based on the Phoenix criteria. Seventy-five patients underwent salvage cryotherapy. Mean patient age was 69.3 years. The overall biochemical salvage rate was 50.7% at a median follow-up of 3.9 years. The following factors were independently associated with successful cryotherapy: Precryotherapy Gleason score of 3 + 3 or 3 + 4, low precryotherapy prostate-specific antigen (PSA), low precryotherapy PSA density, longer time to PSA nadir after radiotherapy, and low postcryotherapy PSA nadir. A postcryotherapy PSA nadir of 0.5 ng/mL or less was associated with a biochemical progression-free survival of 79.7% at 3 years and 64.7% at 5 years, whereas a postcryotherapy PSA nadir above 0.5 was associated with a biochemical progression-free survival of 5.6% at 3 years and 0% at 5 years (p < 0.0001). Approximately 50% of the patients achieved biochemical salvage with cryoablation at 5 years. Nadir PSA after salvage was the strongest predictor of biochemical progression-free survival in our cohort.

Prognostic value of endocan in prostate cancer: clinicopathologic association between serum endocan levels and biochemical recurrence after radical prostatectomy.

To assess the diagnostic capability of serum endocan level in association with clinicopathologic features and its impact on biochemical progression-free survival in patients with prostate cancer (PCa). A total of 86 patients with localized prostate cancer were treated with open radical prostatectomy (RP). The control group included 80 patients who were referred to the urology outpatient clinic with normal rectal examination and prostate-specific antigen (PSA) levels. The patients' characteristics, baseline PSA value, and serum endocan levels were recorded. The patients were followed up with the measurement of PSA concentration every 3 months during the first year, thereafter every 6 months until 5 years, then yearly after surgery. The primary endpoint of follow-up was the time of biochemical recurrence. The median serum endocan levels were 3.14 ng/mL in the RP group and 2.98 ng/mL in the control group (p = 0.122). A total of 86 patients who underwent RP for PCa were divided into 2 groups based on a cutoff serum endocan level of 1.8 ng/mL. The distribution of Gleason score and biochemical failure rate were significantly higher in patients with serum endocan ≥1.8 ng/mL (p = 0.031 and p = 0.047). The biochemical recurrence-free time for endocan ≥1.8 ng/mL and <1.8 ng/mL were 38 and 56 months, respectively (p = 0.041). Spearman correlation analysis showed a linear relationship between endocan expression and Gleason score (p = 0.025, p = 0.511). Multivariate analysis revealed that elevated serum endocan level (≥1.8 ng/mL) was a significant predictor of biochemical progression-free survival (hazard ratio 2.44; 95% confidence interval 1.78-3.23; p = 0.001). The current study indicates that endocan has a close relationship with tumor recurrence in PCa.

1492 BIOCHEMICAL PROGRESSION FREE SURVIVAL AFTER RADICAL PROSTATECTOMY IN MEN WITH HIGH-RISK CLINICALLY LOCALISED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized (VII)1 Apr 20131492 BIOCHEMICAL PROGRESSION FREE SURVIVAL AFTER RADICAL PROSTATECTOMY IN MEN WITH HIGH-RISK CLINICALLY LOCALISED PROSTATE CANCER Joseph Ischia, Larry Goldenberg, Alan So, Peter Black, and Martin Gleave Joseph IschiaJoseph Ischia Vancouver, Canada More articles by this author , Larry GoldenbergLarry Goldenberg Vancouver, Canada More articles by this author , Alan SoAlan So Vancouver, Canada More articles by this author , Peter BlackPeter Black Vancouver, Canada More articles by this author , and Martin GleaveMartin Gleave Vancouver, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2971AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Less than 20% of men with ≥cT3 or very high-risk (by CAPRA score 7-10) prostate cancer receive radical prostatectomy (RP) as their primary treatment due to concerns about the lack of efficacy of surgery as monotherapy and the risk of morbidity. The objective of this study is to report on the biochemical progression-free outcomes of radical prostatectomy in men with high-risk localized prostate cancer, particularly those with ≥cT3 or very high (CAPRA based)-risk. METHODS 565 patients were identified on a prospectively collected database of radical prostatectomy for high-risk clinically localized prostate cancer at a single institution. High risk prostate cancer was defined as having 1 or more of 3 adverse pre-operative parameters: prostate-specific antigen (PSA) >20 ng/mL, biopsy Gleason score 8 to 10 and clinical stage ≥T3. PSA recurrence was defined as a PSA >0.2 ng/mL or initiation of any salvage therapy. Cox regression analysis was used to test for independent predictors of biochemical progression-free survival (bPFS). RESULTS Median age was 63.8 years (45.7-79.6). Median follow-up was 2.4 years (range 0.1-20.2 years). Pre-operatively, 25.8% of men had a PSA>20 ng/mL; 72.6% had a biopsy Gleason score 8 to 10; and 22.5% had clinical stage ≥T3. Moreover, 80% of patients had a single baseline risk factor, 16.8% had 2 risk factors and 3.2% had all 3 risk factors. Neoadjuvant therapy was administered to 279 patients (49%) and adjuvant therapy to 97 (17%); while 230 men (41%) received RP monotherapy. The overall 5 and 10-year bPFS were 60% and 50%, respectively. The 5-year bPFS was 66% for 1 risk factor and 47% for 2 factors; no man with 3 risk factors survived past 2.8 years without a recurrence. The 5-year bPFS for PSA>20 ng/mL, Gleason 8-10, and ≥cT3 were 57%, 56%, and 52% respectively. The 5-yr bPFS for men with very high-risk prostate cancer (CAPRA score 7-10) was 48%. On multivariate analysis, only biopsy Gleason score and the number of risk factors were independent predictors of bPFS. CONCLUSIONS Radical prostatectomy should be considered a primary treatment option in men with high-risk localized prostate cancer. Around half of men with very high-risk disease will be cured with radical prostatectomy as the central (and often only) component of their primary treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e611 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Ischia Vancouver, Canada More articles by this author Larry Goldenberg Vancouver, Canada More articles by this author Alan So Vancouver, Canada More articles by this author Peter Black Vancouver, Canada More articles by this author Martin Gleave Vancouver, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Overexpression of Prostate-Specific TMPRSS2(exon 0)-ERG Fusion Transcripts Corresponds with Favorable Prognosis of Prostate Cancer

To gain insight in the mechanism and clinical relevance of TMPRSS2-ERG expression in prostate cancer, we determined the specific characteristics of fusion transcripts starting at TMPRSS2 exon 1 and at a more upstream and less characterized exon 0. We used quantitative PCR analysis to investigate expression of wild-type TMPRSS2(exon 0) and TMPRSS2(exon 1) and of ERG fusion transcripts. Expression was tested in normal tissue samples, in prostate cancer cell lines and xenografts, and in fresh-frozen clinical prostate cancer samples (primary tumors and recurrences). Expression in clinical samples was correlated with disease progression. TMPRSS2(exon 0) and TMPRSS2(exon 1) transcripts were similarly androgen regulated in prostate cancer cell lines, but the expression levels of TMPRSS2(exon 1) were much higher. Comparison of expression in different tissues showed TMPRSS2(exon 0) expression to be much more prostate specific. In androgen receptor-positive prostate cancer xenografts, TMPRSS2(exon 1) transcripts were expressed at similar levels, but TMPRSS2(exon 0) transcripts were expressed at very variable levels. The same phenomenon was observed for TMPRSS2-ERG fusion transcripts. In clinical prostate cancers, the expression of TMPRSS2(exon 0)-ERG was even more variable. Expression of TMPRSS2(exon 0)-ERG transcripts was detected in 55% (24 of 44) of gene fusion-positive primary tumors but only in 15% (4 of 27) of gene fusion-positive recurrences and at much lower levels. Furthermore, in primary tumors, expression of TMPRSS2(exon 0)-ERG transcripts was an independent predictor of biochemical progression-free survival. The expression of TMPRSS2(exon 0)-ERG fusion transcripts in prostate cancer is associated with a less-aggressive biological behavior.

Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer

According to the European Association of Urology (EAU) guidelines, a life expectancy of > 10 years is considered an important factor in the treatment of prostate cancer. The Charlson score is used to predict mortality based on comorbidities. The purpose of this study was to investigate the relationship between age, Charlson score and outcome in patients with cT3a prostate cancer. Between 1987 and 2004, 200 patients, who were with clinical T3a prostate cancer and who underwent radical prostatectomy (RP), were previously detected by digital rectal examination (DRE). Patients were categorized into two age groups (< 65 and >or= 65 years old). Patients were also divided into two groups according to Charlson score ( = 0 and >or= 1). Both age and Charlson score were analyzed regarding their predictive power of patients' outcomes. The mean follow-up period was 70.6 months, and the mean age of patients was 63.3 years. In all, 106 patients were < 65 years old and 94 patients were >or= 65 years old. Age was a significant predictor of overall survival (OS). A Charlson score of 0 was found in 110 patients, and of >or= 1 in 90 patients. Charlson score was not a significant predictor of biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS) or OS. Cox multivariate analysis showed that margin status was a significant independent factor in BPFS, and cancer volume was a significant independent factor in CPFS. Charlson score does not influence the outcome in patients with clinical locally advanced prostate cancer. Age may influence OS. RP can be performed in motivated healthy older patients. However, the patients need to be counseled regarding possible surgery-related side effects, such as urinary incontinence and erectile dysfunction, which are age- and comorbidity-dependent.

Predictors of biochemical progression-free survival in men who receive radiation therapy after prostatectomy

Predictors of biochemical progression-free survival in men who receive radiation therapy after prostatectomy

Impact of pathology review of stage and margin status of radical prostatectomy specimens (EORTC trial 22911)

Pathological staging and surgical margin status of radical prostatectomy specimens are next to grading the most important prognosticators for recurrence. A central review of pathological stage and surgical margin status was performed on a series of 552 radical prostatectomy specimens of patients, participating in the European Organisation for Research and Treatment of Cancer trial 22911. Inclusion criteria of the trial were pathological stage pT3 and/or positive surgical margin at local pathology. All specimens were totally embedded. Data of the central review were compared with those of local pathologists and related to clinical follow-up. Although a high concordance between review pathology and local pathologists existed for seminal vesicle invasion (94%, kappa=0.83), agreement was much less for extraprostatic extension (57.5%, kappa=0.33) and for surgical margin status (69.4%, kappa=0.45). Review pathology of surgical margin status was a stronger predictor of biochemical progression-free survival in univariate analysis [hazard ratio (HR)=2.16 and p=0.0002] than local pathology (HR=1.08 and p>0.1). The review pathology demonstrated a significant difference between those with and without extraprostatic extension (HR=1.83 and p=0.0017), while local pathology failed to do so (HR=1.05 and p>0.8). The observations suggest that review of pathological stage and surgical margin of radical prostatectomy strongly improves their prognostic impact in multi-institutional studies or trials.

LONG-TERM SALVAGE RADIOTHERAPY OUTCOME AFTER RADICAL PROSTATECTOMY AND RELAPSE PREDICTORS

We assessed the efficacy of salvage radiotherapy (SRT) and analyzed predictors of biochemical progression-free survival (bPFS) and distant metastasis-free survival in patients with clinically localized disease recurrence after radical prostatectomy. The records of 114 patients treated with SRT at 2 institutions between 1991 and 2001 were retrospectively reviewed. Time to biochemical recurrence and to distant metastases was analyzed using the Kaplan-Meier estimation. Candidate predictors of bPFS and distant metastasis-free survival were analyzed using the log rank test and Cox regression. Acute and late complications were scored using Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. At a median followup of 6.3 years (range 1.9 to 13.3) for SRT 4 and 6-year bPFS was 50% (95% CI 42% to 61%) and 33% (95% CI 24% to 43%), respectively. The 6-year actuarial probability of distant metastases after SRT was 14%. Multivariate analysis demonstrated an independent association of increasing Gleason score, lymphovascular invasion and lack of a complete response to SRT with decreased 5-year bDFS. These factors were associated with significantly less 5-year distant metastasis-free survival. Pre-RT prostate specific antigen greater than 2.0 ng/ml was associated with significantly decreased 5-year bDFS and distant metastasis-free survival, although it was not maintained on multivariate analysis. SRT results in durable prostate specific antigen control in select patients. It is well tolerated with few severe late effects. Increasing Gleason score, lymphovascular invasion and lack of a complete response to SRT are significant risks for disease progression requiring additional management.

Impact of the percentage of positive biopsy cores on the further stratification of primary grade 3 and grade 4 Gleason score 7 tumors in radical prostatectomy patients

Objectives To examine whether the percentage of core biopsies positive can further stratify Gleason score 7 patients with primary Gleason grade into precise prognostic groups. Methods Between 1991 and 1999, 379 radical prostatectomy patients were found to have pathologic Gleason 7 tumors. The patients were divided into primary grade 3 or 4. Percentage positive was calculated by dividing the number of positive core biopsies by the total number of cores. Results In the cohort, 290 tumors were primary grade 3, and 89 were primary grade 4. On univariate analysis patients with primary grade 3 tumors had a significant prostate-specific antigen (PSA) progression-free survival advantage over grade 4 patients. When separated according to percentage of core biopsies positive, statistical analysis revealed significantly better 60-month actuarial PSA progression-free survival for patients with grade 3 and grade 4 and less than 50% core biopsies positive as compared with grade 3 and grade 4 and 50% or more core biopsies positive (85%, 85%, 61%, and 33%, respectively). Furthermore, multivariate analysis demonstrated that primary grade did not have an independent impact on biochemical progression-free survival. However, on subset analysis, among patients with 50% or more biopsy cores positive, primary Gleason grade was indeed found to have a significant, independent impact. Conclusions In the present study Gleason 7 patients with primary grade 4 tumors and less than 50% of biopsy cores positive had an excellent prognosis after radical prostatectomy. Our data suggest that among Gleason 7 patients, the percentage of positive biopsies is a stronger predictor of biochemical progression-free survival than primary Gleason grade.