Prostate Size and Adverse Pathologic Features in Men Undergoing Radical Prostatectomy

Abstract Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improve oncologic outcomes in patients with high-risk prostate cancer (PCa) in a recent clinical trial, controversy remains regarding its benefit. We aimed to illustrate national trends of post-RP radiotherapy and compare outcomes and toxicities in patients receiving eRT vs. observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥ pT3N0 and/or positive surgical margins). Our study cohort was consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (IRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both IRT and observation. Trends of post-RP radiotherapy were compared using the Cochran-Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan-Meier analyses compared the eRT and the dRT groups. Results: Among those with pathologically confirmed high-risk PCa after RP, 12.7% (n=959), 13.2% (n=1710), and 74.1% (n=4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p=0.004). Multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Radiation related toxicities, including urinary incontinence, erectile dysfunction, and urethral stricture, were higher in the eRT group when compared to the lRT group. Conclusions: Our results suggest that a blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity.

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THE OUTCOME OF LAPAROSCOPIC EXTRAPERITONEAL RADICAL PROSTATECTOMY IN PATIENTS WITH HIGH BODY MASS INDEX, PRIOR PELVIC SURGERY AND LARGE PROSTATE SIZE

European Urology Supplements ◽

10.1016/s1569-9056(06)60132-2 ◽

2006 ◽

Vol 5 (2) ◽

pp. 54 ◽

Cited By ~ 1

Author(s):

A. Rodriguez ◽

D. Buethe ◽

J. Pow-Sang

Keyword(s):

Body Mass Index ◽

Radical Prostatectomy ◽

Body Mass ◽

High Body Mass Index ◽

Pelvic Surgery ◽

High Body ◽

Prostate Size ◽

Large Prostate

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Prognostic accuracy of prostate health index and urinary prostate cancer antigen 3 in predicting pathologic features after radical prostatectomy

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2015.05.027 ◽

2015 ◽

Vol 33 (11) ◽

pp. 498

Author(s):

Virginie Vlaeminck-Guillem

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Health Index ◽

Cancer Antigen ◽

Prognostic Accuracy ◽

Pathologic Features ◽

Prostate Health Index ◽

Prostate Cancer Antigen ◽

Prostate Health

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The Impact of Prostate Size on Perioperative Outcomes in a Large Laparoscopic Radical Prostatectomy Series

Journal of Endourology ◽

10.1089/end.2008.0366 ◽

2009 ◽

Vol 23 (1) ◽

pp. 147-152 ◽

Cited By ~ 20

Author(s):

Adam W. Levinson ◽

Nicholas T. Ward ◽

Aaron Sulman ◽

Lynda Z. Mettee ◽

Richard E. Link ◽

...

Keyword(s):

Radical Prostatectomy ◽

Laparoscopic Radical Prostatectomy ◽

Perioperative Outcomes ◽

Prostate Size ◽

The Impact

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Advancing age and the risk of adverse pathology at radical prostatectomy in men with biopsy Gleason score 6 prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.289 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 289-289

Author(s):

Daniel Kim ◽

Ming-Hui Chen ◽

Hartwig Huland ◽

Markus Graefen ◽

Derya Tilki ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Specific Antigen ◽

Cancer Center ◽

Study Cohort ◽

Pathologic Features ◽

Younger Men ◽

Biopsy Gleason Score ◽

The Impact

289 Background: We evaluated the impact of age > 65 years versus younger on the odds of finding adverse pathologic features (pT3/T4 and/or R1 and/or Gleason score 8, 9, 10) at radical prostatectomy (RP) among men with biopsy Gleason score 6 prostate cancer (PC). Methods: The study cohort comprised 3191 men with biopsy Gleason score 6 PC treated with a RP between February 28, 1992 and February 15, 2016 at the Martini-Klinik Prostate Cancer Center. Multivariable logistic regression was used to evaluate the impact of age > 65 years versus younger on the adjusted odds ratio (AOR) of finding adverse pathology at RP adjusting for pre-RP prostate specific antigen (PSA), clinical tumor category, year of diagnosis, percent positive biopsies (PPB), and PSA density (PSAd). Results: Men age > 65 years as compared to younger had significantly lower median PPB (16.67% vs 20.0%; p = 0.01) and PSAd (0.13 ng/mL vs 0.15 ng/mL; p < 0.0001). Yet, while both increasing PPB (AOR 1.018, 95% CI 1.013, 1.023; p- < 0.0001) and PSAd (AOR 4.28, 95% CI 1.66, 11.01; p = 0.003) were significantly associated with an increased odds of finding adverse pathology at RP, men age > 65 years versus younger had a higher odds of adverse pathology at RP (AOR 1.28, 95% CI 1.002, 1.62; p = 0.048). Conclusions: Despite a more favorable median PPB and PSAd, men with biopsy Gleason score 6 PC and who are age > 65 years compared to younger men are at higher risk for having adverse pathology at RP and may benefit from a multiparametric MRI and targeted biopsy before proceeding with active surveillance. If higher grade/stage disease is discovered and treatment indicated then this information could guide both the use and duration of supplemental androgen deprivation therapy in men considering radiation therapy.

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