Predicting Recurrence After Radical Prostatectomy for Patients With High Risk Prostate Cancer

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jan 2003Predicting Recurrence After Radical Prostatectomy for Patients With High Risk Prostate Cancer GARY D. GROSSFELD, DAVID M. LATINI, DEBORAH P. LUBECK, SHILPA S. MEHTA, and PETER R. CARROLL GARY D. GROSSFELDGARY D. GROSSFELD , DAVID M. LATINIDAVID M. LATINI , DEBORAH P. LUBECKDEBORAH P. LUBECK , SHILPA S. MEHTASHILPA S. MEHTA , and PETER R. CARROLLPETER R. CARROLL View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64058-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Previous studies have shown that patients with clinical stage T2c-T3 prostate cancer, serum prostate specific antigen (PSA) at diagnosis greater than 20 ng./ml. or a biopsy Gleason score of 8 to 10 are at high risk for disease recurrence after radical prostatectomy. We determined the most important pretreatment predictors of disease recurrence in this high risk population. Materials and Methods: We identified 547 patients with high risk prostate cancer who underwent radical prostatectomy at University of California, San Francisco or as part of the Cancer of the Prostate Strategic Urological Research Endeavor data base, a longitudinal disease registry of patients with prostate cancer. High risk disease was defined as 1992 American Joint Committee on Cancer clinical stage T2c-T3 disease in 411 patients, serum PSA at diagnosis greater than 20 ng./ml. in 124 and/or biopsy Gleason score 8 to 10 in 114. Disease recurrence was defined as PSA 0.2 ng./ml. or greater on 2 consecutive occasions after radical prostatectomy or second cancer treatment more than 6 months after surgery. The Cox proportional hazards analysis was performed to determine significant independent predictors of disease recurrence. The likelihood of disease recurrence for clinically relevant patient groups was determined using the Kaplan-Meier method and compared using the log rank test. Results: Median followup after surgery was 3.1 years. Disease recurred in 177 patients (32%). Multivariate analysis demonstrated that serum PSA at diagnosis, biopsy Gleason score, ethnicity and the percent of positive prostate biopsies were significant independent predictors of disease recurrence, while patient age and clinical tumor stage were not. Patients with a Gleason score 8 to 10 tumor and a serum PSA of 10 ng./ml. or less had a significantly higher likelihood of remaining disease-free 5 years after surgery than those with PSA greater than 10 ng./ml. (47% versus 19%, p <0.05). Patients with a serum PSA at diagnosis of greater than 20 ng./ml. and a Gleason score of less than 8 had a significantly higher likelihood of remaining disease-free 5 years after surgery than similar patients with a Gleason score of 8 or greater (45% versus 0%, p <0.05). Conclusions: PSA, Gleason score, ethnicity and the percent of positive prostate biopsies appear to be the most important pretreatment predictors of disease recurrence in men with high risk prostate cancer. Patients with high grade disease may continue to be appropriate candidates for local therapy if PSA is less than 10 ng./ml. at diagnosis or there are fewer than 66% positive prostate biopsies. References 1 : Cancer of the prostate. In: Cancer: Principles and Practice of Oncology. Edited by . Philadelphia: Lippincott Williams and Wilkins2001: 1418. chapt. XX. Google Scholar 2 : Predicting disease recurrence in intermediate and high-risk patients undergoing radical prostatectomy using percent positive biopsies: results from CaPSURE. Urology2002; 59: 560. Google Scholar 3 : Predicting prostate specific antigen outcome preoperatively in the prostate specific antigen era. J Urol2001; 166: 2185. Link, Google Scholar 4 : Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA1993; 270: 948. Google Scholar 5 : Population-based prostate cancer trends in the PSA-era: data from the surveillance, epidemiology, and end results (SEER) program. Monogr Urol1998; 19: 1. Google Scholar 6 : Early prostate cancer detection and potential for surgical cure in men with poorly differentiated tumors. Urology1998; 52: 106. Google Scholar 7 : Radical prostatectomy for pathological Gleason 8 or greater prostate cancer: influence of concomitant pathological variables. J Urol2002; 167: 117. Link, Google Scholar 8 : The CaPSURE database: a methodology for clinical practice and research in prostate cancer. CaPSURE Research Panel. Cancer of the Prostate Strategic Urologic Research Endeavor. Urology1996; 48: 773. Google Scholar 9 : Clinical utility of the percentage of positive prostate biopsies in defining biochemical outcome after radical prostatectomy for patients with clinically localized prostate cancer. J Clin Oncol2000; 18: 1164. Google Scholar 10 : Does the completeness of prostate sampling predict outcome for patients undergoing radical prostatectomy?: data from the CAPSURE database. Urology2000; 56: 430. Google Scholar 11 : Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high Gleason grade prostate carcinoma. Cancer1998; 83: 989. Google Scholar 12 : Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med1997; 337: 295. Google Scholar 13 : Neoadjuvant chemotherapy and hormonal therapy followed by radical prostatectomy: feasibility and preliminary results. J Clin Oncol2000; 18: 1050. Google Scholar 14 : Implications of stage-specific survival rates in assessing recent declines in prostate cancer mortality rates. Epidemiology2000; 11: 167. Google Scholar 15 : Outcome of patients with Gleason score 8 or higher prostate cancer following radical prostatectomy alone. J Urol2002; 167: 1675. Link, Google Scholar 16 : Under staging and under grading in a contemporary series of patients undergoing radical prostatectomy: results from the Cancer of the Prostate Strategic Urologic Research Endeavor database. J Urol2001; 165: 851. Link, Google Scholar 17 : Correlation of prostate needle biopsy and radical prostatectomy Gleason grade in academic and community settings. Am J Surg Pathol1997; 21: 566. Google Scholar 18 : Percent prostate needle biopsy tissue with cancer is more predictive of biochemical failure or adverse pathology after radical prostatectomy than prostate specific antigen or Gleason score. J Urol2002; 167: 516. Link, Google Scholar 19 : The clinical utility of the percent of positive prostate biopsies in predicting biochemical outcome following external-beam radiation therapy for patients with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys2001; 49: 679. Google Scholar 20 : Is ethnicity an independent predictor of prostate cancer recurrence following radical prostatectomy?. J Urol2002; 168: 2510. Abstract, Google Scholar From the Department of Urology, Program in Urologic Oncology, Urology Outcomes Research Group and University of California-San Francisco Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California, and TAP Pharmaceutical Products, Inc., Lake Forest, Illinois© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByPerlis N, Sayyid R, Evans A, Van Der Kwast T, Toi A, Finelli A, Kulkarni G, Hamilton R, Zlotta A, Trachtenberg J, Ghai S and Fleshner N (2018) Limitations in Predicting Organ Confined Prostate Cancer in Patients with Gleason Pattern 4 on Biopsy: Implications for Active SurveillanceJournal of Urology, VOL. 197, NO. 1, (75-83), Online publication date: 1-Jan-2017.Cole A, Morgan T, Spratt D, Palapattu G, He C, Tomlins S, Weizer A, Feng F, Wu A, Siddiqui J, Chinnaiyan A, Montgomery J, Kunju L, Miller D, Hollenbeck B, Wei J and Mehra R (2018) Prognostic Value of Percent Gleason Grade 4 at Prostate Biopsy in Predicting Prostatectomy Pathology and RecurrenceJournal of Urology, VOL. 196, NO. 2, (405-411), Online publication date: 1-Aug-2016.Pastuszak A, Pearlman A, Lai W, Godoy G, Sathyamoorthy K, Liu J, Miles B, Lipshultz L and Khera M (2018) Testosterone Replacement Therapy in Patients with Prostate Cancer After Radical ProstatectomyJournal of Urology, VOL. 190, NO. 2, (639-644), Online publication date: 1-Aug-2013.Nakanishi H, Troncoso P and Babaian R (2018) Prediction of Extraprostatic Extension in Men With Biopsy Gleason Score of 8 or GreaterJournal of Urology, VOL. 180, NO. 6, (2441-2446), Online publication date: 1-Dec-2008.COOPERBERG M, BROERING J, LITWIN M, LUBECK D, MEHTA S, HENNING J and CARROLL P (2018) THE CONTEMPORARY MANAGEMENT OF PROSTATE CANCER IN THE UNITED STATES: LESSONS FROM THE CANCER OF THE PROSTATE STRATEGIC UROLOGIC RESEARCH ENDEAVOR (CAPSURE), A NATIONAL DISEASE REGISTRYJournal of Urology, VOL. 171, NO. 4, (1393-1401), Online publication date: 1-Apr-2004. Volume 169Issue 1January 2003Page: 157-163 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsbiopsyprostateprostatic neoplasmsprostatectomyprostate-specific antigenMetricsAuthor Information GARY D. GROSSFELD More articles by this author DAVID M. LATINI More articles by this author DEBORAH P. LUBECK More articles by this author SHILPA S. MEHTA Requests for reprints: Supported by National Institutes of Health/National Cancer Institute University of California-San Francisco SPORE Special Program of Research Excellence 1 p50 c89520 and TAP Pharmaceutical Products. Financial interest and/or other relationship with TAP Pharmaceuticals. More articles by this author PETER R. CARROLL Financial interest and/or other relationship with Astra Zeneca, ATI Medical, Imetrinus, MEL and TAP Pharmaceuticals. More articles by this author Expand All Advertisement PDF DownloadLoading ...