Radical retropubic prostatectomy in patients with high risk prostate cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15549-15549
Author(s):  
E. Özgür ◽  
C. Ohlmann ◽  
D. Pfister ◽  
U. Engelmann ◽  
A. Heidenreich
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Gleason Score ◽  
Serum Levels ◽  
Radical Retropubic Prostatectomy ◽  
Cancer Specific Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Psa Recurrence ◽  
Biopsy Gleason Score

15549 Background: Patients with high risk prostate cancer (Gleason score 8 to 10, cT3 disease or PSA > 20 ng/ml) are at high for cancer recurrence after local therapy such as radical retropubic prostatectomy (RPE) or radiation therapy. We examined the long-term oncological and functional outcome of patients with high risk prostate cancer (PCA) on biopsy. We further investigated prognostic risk factors associated with good prognosis. Methods: We retrospectively analysed the outcome of 304 patients with high risk PCA. All patients received a questionnaire to obtain information with regard to continence, potency, PSA recurrence, PSA mortality and quality of life (EORTC QLQ-30). 237 (78%) patients returned the questionnaires. Results: The mean follow-up is 94 (15–146) months, mean age of all patients is 62.6 (32–78) years. 231 (76%) patients had PSA serum levels of 20–50ng/ml, 62 (23.4%) and 39 (12.8%) had PSA serum levels of 50–100 ng/ml and > 100 ng/ml, resp., a pT3 PCA was identified in 192 (63.1%) patients, pTxpN1 disease was found in 84 (27.6%) patients. Overall survival rate is 81.9%, 86.2% and 85.3% in patients with PSA > 20ng/ml, pT3 or pTxpN1 PCA, resp.; cancer specific survival was 85%, 89.5% and 88.7% in PSA > 20ng/ml, pT3 and pTxpN1 PCA, resp. PSA recurrence rate is 28%; the most significant parameters associated with survival are biopsy Gleason score (p = 0.02), pN1 status (p = 0.001), perineural invasion (p = 0.001), seminal vesicle invasion (p < 0.0005). There was no significant difference with regard to pre- and postoperative quality of life. Continence was good with no pads in 85%, 1- 2 pads/day and = 3 pads/day in 10.6% and 4.4%, resp. Conclusions: RPE can be safely performed in patients with high risk PCA resulting in a high cancer specific survival rate. Most suitable candidates are patients with biopsy Gleason score < 8, pN0 and = pT3a; even in cT3 PCA RPE is a valuable therapeutic option with long-term PCA-free survival and might be considered in men with a long life expectancy. No significant financial relationships to disclose.

998 HIGH-RISK PROSTATE CANCER PRESENTING WITH BIOPSY GLEASON SCORE 8, 9 OR 10: DOWNGRADING AND CANCER-SPECIFIC SURVIVAL

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Steven Joniau ◽  
Martin Spahn ◽  
Jongi Chun ◽  
Patrick Bastian ◽  
Alberto Briganti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Gleason Score ◽  
Cancer Specific Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Biopsy Gleason Score

The effect of pathologic T-stage and Gleason score on cancer-specific survival for specimen-confined high-risk prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 114-114
Author(s):  
Lorenzo Tosco ◽  
Hendrik Van Poppel ◽  
Thomas Van den Broeck ◽  
Patrick Bastian ◽  
Alberto Briganti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Gleason Score ◽  
Proportional Hazards Model ◽  
Cox Model ◽  
Cox Proportional Hazards Model ◽  
Cancer Specific Survival ◽  
High Risk Prostate Cancer ◽  
Kaplan Meier ◽  
Risk Prostate Cancer

114 Background: High-risk prostate cancer (HRPC) is a challenging disease and the role of surgery is often considered in the context of a multimodal approach. The indication for adjuvant therapy after surgery for HRPC patients who have specimen-confined disease (R0, pN0, <pT3b) is still difficult. The current study aims to analyze postoperative pathological features which help to predict CSS in specimen-confined HRPC and thus may aid in the decision to administer adjuvant EBRT or ADT. Methods: From a multi-institutional retrospective cohort of 5876 HRPC patients treated by radical prostatectomy and pelvic lymph node dissection, 1391 patients with specimen-confined disease were selected. Following surgery, adjuvant EBRT and/or ADT were delivered according to institutional protocols. Patients were subdivided into four groups according to pT stage (pT≥3 and pT<3) and final Gleason score (GS≥8 and GS<8). Kaplan-Meier plots with log-rank tests and a Cox proportional hazards model were applied to study CSS. All significance levels were set at 0.05. MedCalc was used for all statistical analyses. Results: Median age was 65 years (43-84). Of all patients, 346 (24.9%) had GS≥8 and 794 (57.1%) had pT≥3 at definitive histopathology. Patients were classified into COMBO groups: C1 (478; 34.4%; GS<8,pT<3), C2 (567; 40.8%; GS<8, pT≥3), C3 (119; 8.6%; GS≥8, pT<3), C4 (227; 16.3%; GS≥8, pT≥3). Adjuvant EBRT and ADT, respectively, were delivered in C1 2%/2%, C2 15%/22%, C3 3%/10%, C4 18%/25%. Kaplan Meier plots demonstrated statistically different 10-yr CSS between groups: C1 97.4%, C2 95.2%, C3 89.9% and C4 84.4% (p<0.0001). COMBO groups were also compared using a Cox model and results are shown in the Table. Conclusions: COMBO groups demonstrated to be able to subdivide specimen-confined HRPC into 4 demarcated groups with significantly different CSS. This subdivision could be considered an easy-to-use tool which can help for counseling patients for adjuvant treatment strategies. [Table: see text]

The effect of pathologic T-stage and Gleason score on cancer-specific survival in patients with positive surgical margins after surgery for high-risk prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 140-140
Author(s):  
Lorenzo Tosco ◽  
Hendrik Van Poppel ◽  
Thomas Van den Broeck ◽  
Patrick Bastian ◽  
Alberto Briganti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Gleason Score ◽  
Proportional Hazards Model ◽  
Cox Model ◽  
Cox Proportional Hazards Model ◽  
Cancer Specific Survival ◽  
High Risk Prostate Cancer ◽  
Kaplan Meier ◽  
Risk Prostate Cancer

140 Background: High-risk prostate cancer (HRPC) is a challenging disease and the role of surgery is often considered in the context of a multimodal approach but patients with positive section margins (R1) disease have not always the same cancer-specific survival (CSS). The current study aims to analyze current postoperative pathological features in order to predict CSS of HRPC patients with R1, but with negative lymph nodes (pN0), treated with surgery. Methods: From a multi-institutional retrospective cohort of 5,876 HRPC patients treated by radical prostatectomy and pelvic lymph node dissection, 1541 patients with pN0 and R1 were selected. Following surgery, adjuvant EBRT and/or ADT were delivered according to institutional protocols. Patients were subdivided into four groups according to pT stage (pT≥3 and pT<3) and p-Gleason score (pGS≥8 and pGS<8). Kaplan-Meier plots with log-rank tests and a Cox proportional hazards model were applied to study CSS. All significance levels were set at 0.05. MedCalc was used for all statistical analyses. Results: Median age at surgery was 66 years (42-89). Of all patients, 399 (25.9%) had GS≥8 and 999 (64.8%) had pT≥3 at definitive histopathology. Patients were classified as COMBO groups: C1 (423; 27.4%; GS<8,pT<3), C2 (674; 43.7%; GS<8, pT≥3), C3 (83; 5.4%; GS≥8, pT<3), C4 (362; 23.5%; GS≥8, pT≥3). Adjuvant EBRT and ADT, respectively, were delivered in C1 3%/5%, C2 15%/21%, C3 21%/20%, C4 28%/40%. Kaplan-Meier plots demonstrated statistically different 10-yr CSS between groups: C1 97%, C2 93.8%, C3 85.1% and C4 77.3% (p<0.0001). COMBO groups were also compared using a Cox model and results are shown in the Table. Conclusions: COMBO groups demonstrated to be able to subdivide margin-positive, pN0 HRPC into 4 demarcated groups with significantly different CSS. This subdivision could be considered an easy-to-use tool which can help for counseling patients for adjuvant treatment strategies. [Table: see text]

scholarly journals Radical Prostatectomy: An Option for High-Risk Prostate Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
S. Rausch ◽  
C. Schmitt ◽  
T. Kälble
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Locally Advanced ◽  
Radical Retropubic Prostatectomy ◽  
Cancer Specific Survival ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Introduction. High-risk prostate cancer represents a therapeutic challenge. The role of radical prostatectomy (RP) in patients with extreme PSA values is under discussion.Material and Methods. We retrospectively analysed our data of 56 consecutive patients with preoperative PSA ≥ 40 mg/mL undergoing open radical retropubic prostatectomy from 1999 to 2009. Patient survival and time to PSA recurrence were recorded, and the Kaplan-Meier survival analysis was performed. Postoperative quality of life and functional status were investigated using a SF-12 questionnaire and determining the number of pads used per day.Results. Overall 56 patients were available for followup after a median time of 83.84 months. Locally advanced carcinoma was present in 84% while 16% of patients had organ-confined stages. A positive nodal status was observed in 46%. Overall survival was 95% at five and 81% at 10 years. Cancer-specific survival was 100% for five years and 83% for 10 years. Corresponding biochemical recurrence-free survival was low (52% and 11%, resp.). Quality of life and functional outcomes were favourable.Conclusions. In patients with PSA ≥ 40 mg/mL, RP allows long-term control, exact planning of adjuvant treatment, and identification of curable disease.

1413: Radical Retropubic Prostatectomy in Patients with High Risk Prostate Cancer

2007 ◽  
Vol 177 (4S) ◽  
pp. 466-466
Author(s):  
David Thüer ◽  
Carsten H. Ohlmann ◽  
David Pfister ◽  
Dina Sahi ◽  
Udo Engelmann ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Retropubic Prostatectomy ◽  
Retropubic Prostatectomy ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

scholarly journals Circulating mRNA signature as a marker for high-risk prostate cancer

2019 ◽  
Vol 41 (2) ◽  
pp. 139-145
Author(s):  
Marilesia Ferreira De Souza ◽  
Hellen Kuasne ◽  
Mateus De Camargo Barros-Filho ◽  
Heloísa Lizotti Cilião ◽  
Fabio Albuquerque Marchi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Specific Antigen ◽  
Treatment Decision ◽  
Tumor Stage ◽  
Aggressive Disease ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Invasive Method ◽  
Biopsy Gleason Score

Abstract Prostate cancer (PCa) is the second most common cancer in men. The indolent course of the disease makes the treatment choice a challenge for physicians and patients. In this study, a minimally invasive method was used to evaluate the potential of molecular markers in identifying patients with aggressive disease. Cell-free plasma samples from 60 PCa patients collected before radical prostatectomy were used to evaluate the levels of expression of eight genes (AMACR, BCL2, NKX3-1, GOLM1, OR51E2, PCA3, SIM2 and TRPM8) by quantitative real-time PCR. Overexpression of AMACR, GOLM1, TRPM8 and NKX3-1 genes was significantly associated with aggressive disease characteristics, including extracapsular extension, tumor stage and vesicular seminal invasion. A trio of genes (GOLM1, NKX3-1 and TRPM8) was able to identify high-risk PCa cases (85% of sensitivity and 58% of specificity), yielding a better overall performance compared with the biopsy Gleason score and prostate-specific antigen, routinely used in the clinical practice. Although more studies are required, these circulating markers have the potential to be used as an additional test to improve the diagnosis and treatment decision of high-risk PCa patients.

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