The Long-Term Outcomes after Radical Prostatectomy of Patients with Pathologic Gleason 8–10 Disease

Background. We explored the long-term clinical outcomes including metastases-free survival and prostate cancer-specific survival (PCSS) in patients with pathologic Gleason 8–10 disease after radical prostatectomy (RP).Methods. We report on 91 patients with PCSS data with a median followup of 8.2 years after RP performed between 1988 and 1997. Cox regression and Kaplan-Meier analysis were used to evaluate year of surgery, pathologic stage, and surgical margin status as predictors of PCSM.Results. Median age was 65 years (IQR: 61–9), and median PSA was 9.7 ng/ml (IQR: 6.1–13.4). Of all patients, 62 (68.9%) had stage T3 disease or higher, and 48 (52.7%) had a positive surgical margin. On multivariate analysis, none of the predictors were statistically significant. Of all patients, the predicted 10-year BCR-free survival, mets-free survival, and PCSS were 59% (CI: 53%–65%), 88% (CI: 84%–92%), and 94% (CI: 91%–97%), respectively.Conclusions. We have demonstrated that cancer control is durable even 10 years after RP in those with pathologic Gleason 8–10 disease. Although 40% will succumb to BCR, only 6% of patients died of their disease. These results support the use of RP for patients with high-risk localized prostate cancer.

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IMPORTANCE OF THE LEARNING CURVE IN REDUCING POSITIVE SURGICAL MARGIN RATE AND IMPROVING BIOCHEMICAL PROGRESSION FREE SURVIVAL AFTER RADICAL PROSTATECTOMY FOR CT3A PROSTATE CANCER

European Urology Supplements ◽

10.1016/s1569-9056(08)60383-8 ◽

2008 ◽

Vol 7 (3) ◽

pp. 167 ◽

Cited By ~ 1

Author(s):

C-Y. Hsu ◽

S. Joniau ◽

R. Oyen ◽

T. Roskams ◽

H. Van Poppel

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Learning Curve ◽

Surgical Margin ◽

Progression Free Survival ◽

Positive Surgical Margin ◽

Free Survival ◽

Biochemical Progression

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The role of whole pelvic nodal radiotherapy compared with prostate bed only radiotherapy after radical prostatectomy for prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.93 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 93-93 ◽

Cited By ~ 1

Author(s):

Matthieu Caubet ◽

David Pasquier ◽

Aurelie Bertaut ◽

Simon Grobois ◽

Berardino De Bari ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Postoperative Radiotherapy ◽

Surgical Margin ◽

Disease Free Survival ◽

Positive Surgical Margin ◽

Free Survival ◽

Prostate Bed ◽

Gu Toxicity ◽

Gi Toxicity

93 Background: In international guidelines, target volumes for postoperative radiotherapy (PORT) after radical prostatectomy concern the bed of the prostate and seminal vesicles. The benefit of whole pelvic nodal radiotherapy (WPRT) in the case of PORT remains uncertain. Methods: We reviewed the charts of all patients diagnosed with high-risk prostate cancer after radical prostatectomy who were selected for PORT and treated with adjuvant radiotherapy (n = 242, 43.1%) or early salvage RT (n = 320, 56.9%) between 2002 and 2011. 111 patients (19.8%) who underwent WPRT were compared with 441 patients (80.2%) who had prostate bed radiotherapy only (PBRT). We examined associations between patient, tumor, and treatment characteristics and biochemical progression-free survival (bPFS), disease-free survival (DFS) and overall survival (OS) with uni- and multivariate analyses using Cox models. Acute and late toxicities were also compared between the two groups. Results: We found a significantly lower rate of acute G2+ gastrointestinal (GI) toxicity with PBRT than with WPRT with neither difference in acute G3+ nor on late GI toxicity. Regarding genitoruinary (GU) toxicity, we found no difference in acute G2+ or G3+ toxicity but rates of late G3+ GU toxicity were significantly lower in PBRT (1.55%) than in WPRT patients (p = 0.035). With a median follow-up of 65.2 months [95% CI: 62.8 - 67.9], a deleterious effect of WPRT was observed on OS (HR = 3.27 [95% CI: 1.44 - 7.45], p = 0.009). We found no impact of WPRT on bPFS (HR = 0.79 [95% CI: 0.49 - 1.25], p = 0.31) or DFS (HR = 0.97 [95% CI: 0.63 - 1.49], p = 0.88). Only a positive surgical margin was an independent prognostic factor for better bPFS. Age≥63 years and WPRT (HR = 2.86 [95% CI: 1.20-6.80], p = 0.018) were independent prognostic factors for worse OS. Conclusions: After radical prostatectomy, we found no difference on bPFS or DFS but lower rates of OS with WPRT compared to PBRT. PBRT must remain the standard of care. The results of RTOG NRG Oncology 0534 should shed light on this unresolved issue.

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The role of fatal family history and mode of inheritance in prostate cancer for long-term outcomes following radical prostatectomy

World Journal of Urology ◽

10.1007/s00345-020-03147-6 ◽

2020 ◽

Vol 38 (12) ◽

pp. 3091-3099 ◽

Cited By ~ 1

Author(s):

Valentin H. Meissner ◽

Jamila G. H. Strüh ◽

Martina Kron ◽

Lea A. Liesenfeld ◽

Stephanie Kranz ◽

...

Keyword(s):

Prostate Cancer ◽

Prognostic Factors ◽

Family History ◽

Radical Prostatectomy ◽

Cox Regression ◽

Long Term Outcomes ◽

Long Term Outcome ◽

Kaplan Meier ◽

Mode Of Inheritance

Abstract Purpose To determine whether fatal family history (FFH) or mode of inheritance in prostate cancer (PCa) has an impact on long-term outcomes following radical prostatectomy (RP). Methods 1076 PCa patients after RP with at least one deceased first-degree relative with PCa were included and stratified by FFH (four subgroups: fraternal, paternal, multiple, and none) and by mode of inheritance (two subgroups: male to male, non-male to male). We compared clinicopathological characteristics between subgroups with Fisher’s exact or Chi-square tests. Biochemical recurrence-free survival (BRFS) and cancer-specific survival (CSS) were analyzed using the method of Kaplan and Meier. Simple and multiple Cox regression with backward elimination were performed to select prognostic factors for BRFS and CSS. Results Median age at surgery was 63.3 (range 35.9–79.4) years. The overall Kaplan–Meier estimated BRFS rate at 10 and 15 years was 65.6% and 57.0%, respectively. The overall Kaplan–Meier estimated CSS rate at 10 and 15 years was 98.1% and 95.7%, respectively. Neither FFH nor mode of inheritance were factors associated with worse BRFS. However, in multiple Cox regression, paternal FFH was an important prognostic factor for a better CSS (HR 0.19, CI 0.05–0.71, p = 0.014) compared to non-FFH. Conclusion FFH and mode of inheritance do not seem to be prognostic factors of worse long-term outcomes following RP. Rather, a paternal FFH was associated with a better CSS; however, the reasons remain unclear. Nevertheless, patients after RP and FFH could be reassured that their own PCa diagnosis is not associated with a worse long-term outcome.

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Oncologic Outcomes of Surgery in T3 Prostate Cancer: Experience of a Single Tertiary Center

Advances in Urology ◽

10.1155/2012/164263 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

D. Milonas ◽

G. Smailyte ◽

M. Jievaltas

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Cox Regression ◽

Progression Free Survival ◽

Oncologic Outcomes ◽

Cancer Specific Survival ◽

Free Survival ◽

Risk Of Death ◽

Tertiary Center

Aim. The aim of this study is to present the oncologic outcomes and to determine the prognostic factors of overall survival (OS), cancer-specific survival (CSS), disease-progression-free survival (DPFS), and biochemical-progression-free survival (BPFS) after surgery for pT3 prostate cancer (PCa).Methods. Between 2002 and 2007, a pT3 stage after radical prostatectomy was detected in 182 patients at our institution. The Kaplan-Meier analysis was used to calculate OS, CSS, DPFS, and BPFS. Cox regression was used to identify predictive factors of survival.Results. pT3a was detected in 126 (69%) and pT3b in 56 (31%) of cases. Five-year OS, CSS, DPFS, and BPFS rates were 90.7%, 94%, 91.8%, and 48.4%, respectively. Survival was significantly different when comparing pT3a to pT3b groups. The 5-year OS, CSS, DPFS, and BPFS were 96% versus 72%, 98% versus 77%, 97.3% versus 79.3%, and 60% versus 24.2%, respectively. Specimen Gleason score was the most significant predictor of OS, CSS, DPFS, and BPFS. The risk of death increased up to 3-fold when a Gleason score 8–10 was present at the final pathology.Conclusions. Radical prostatectomy may offer very good CSS, OS, DPFS, and BPFS rates in pT3a PCa. However, outcomes in patients with pT3b or specimen Gleason ≥8 were significantly worse, suggesting the need for multimodality treatment in those cases.

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Long-term and pathological outcomes of low- and intermediate-risk prostate cancer after radical prostatectomy: implications for active surveillance

World Journal of Urology ◽

10.1007/s00345-021-03717-2 ◽

2021 ◽

Author(s):

Valentin H. Meissner ◽

Mira Woll ◽

Donna P. Ankerst ◽

Stefan Schiele ◽

Jürgen E. Gschwend ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Clinical Decision Making ◽

Cox Regression ◽

Clinical Decision ◽

Low Risk ◽

Intermediate Risk ◽

Cancer Specific Survival

Abstract Purpose The safety of active surveillance (AS) in favorable intermediate-risk (FIR) prostate cancer (PCa) remains uncertain. To provide guidance on clinical decision-making, we examined long-term and pathological outcomes of low-risk and intermediate-risk PCa patients after radical prostatectomy (RP). Methods The study involved 5693 patients diagnosed between 1994 and 2019 with low-risk, FIR, and unfavorable intermediate-risk (UIR) PCa (stratification according to the AUA guidelines) who underwent RP. Pathological outcomes were compared, and Kaplan–Meier analysis determined biochemical recurrence-free survival (BRFS) and cancer-specific survival (CSS) at 5, 10, 15, and 20 years. Multiple Cox regression was used to simultaneously control for relevant confounders. Results Those at FIR had higher rates of upgrading and upstaging (12.8% vs. 7.2%, p < 0.001; 19.8% vs. 12.0%, p < 0.001) as well as pathological tumor and node stage (≥ pT3a: 18.8% vs. 11.6%, p < 0.001; pN1: 2.7% vs. 0.8%, p > 0.001) compared to patients at low risk. The 20-year BRFS was 69%, 65%, and 44% and the 20-year CSS was 98%, 95%, and 89% in low-risk, FIR, and UIR patients. On multiple Cox regression, FIR was not associated with a worse BRFS (HR 1.07, CI 0.87–1.32), UIR was associated with a worse BRFS (HR 1.49, CI 1.20–1.85). Conclusion Patients at FIR had only slightly worse pathological and long-term outcomes compared to patients at low risk, whereas the difference compared to patients at UIR was large. This emphasizes AS in these patients as a possible treatment strategy in well-counseled patients.

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Radical Prostatectomy in High-Risk Prostate Cancer Patients: Results of a Single- Institution Study

Songklanagarind Medical Journal ◽

10.31584/smj.2018.36.1.766 ◽

2018 ◽

Vol 36 (1) ◽

pp. 45

Author(s):

Virote Chalieopanyarwong ◽

Worapat Attawettayanon ◽

Watid Kanchanawanichkul ◽

Choosak Pripatnanont

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Cancer Control ◽

Clinical Recurrence ◽

High Risk Prostate Cancer ◽

Kaplan Meier ◽

Pathologic Staging ◽

Risk Prostate Cancer

Objective: To evaluate long-term outcomes of radical prostatectomy and bilateral pelvic lymph node dissection (RP) for high-risk prostate cancer (PC).Material and Method: A retrospective review of high-risk PC patients who received RP, identified from medical records. We collected data from Songklanagarind Hospital, Prince of Songkla University from 2007 to 2015. The Kaplan-Meier method and Cox proportional regression models were used to analyze clinical recurrence (CR) and biochemical recurrence (BCR).Results: In 79 patients, the median follow-up was 27.2 months. The 3-year and 5-year biochemical free survival in men with high-risk PC were 67.7% and 62.9% respectively. Multivariate analysis shows that pathologic stage 3a (hazard ratio=4.87; 95% confidence interval=1.01-23.38) was independently associated with cancer control.Conclusion: Data support the belief that RP has a place in the treatment of high-risk PC. RP was a long-term cancer control in patients with high-risk PC. Only pathologic staging was independently associated with cancer control outcome.

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