Predicting the long-term risk of prostate cancer-specific mortality after radical prostatectomy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5007-5007
Author(s):  
A. J. Stephenson ◽  
E. A. Klein ◽  
M. W. Kattan ◽  
M. Han ◽  
A. W. Partin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Seminal Vesicle ◽  
Specific Antigen ◽  
Gleason Grade ◽  
Seminal Vesicle Invasion ◽  
Pathologic Features ◽  
Specific Mortality ◽  
Cancer Specific Mortality

5007 Background: Nomograms that predict prostate-specific antigen (PSA) defined biochemical recurrence (BCR) of prostate cancer after radical prostatectomy are the most widely used prediction tools in oncology for treatment decision making and counseling. While BCR universally antedates prostate cancer-specific mortality (PCSM), it is a limited surrogate endpoint due to its variable natural history. Nomograms that accurately predict the risk of PCSM are needed. Methods: Using Fine and Gray competing risk regression analysis, the clinical data and follow-up information of 11,521 patients treated with radical prostatectomy at four academic centers from 1987 to 2005 were modeled to predict PCSM. The model was externally validated on 12,893 patients treated at a separate institution during the same period. Results: The 15-year PCSM and all-cause mortality was 7% and 33%, respectively. The 15-year PCSM for patients with final pathological Gleason score 2–6, 3+4, 4+3, and 8–10 was 1%, 7%, 8%, and 49%, respectively. By pathologic stage, the risks were 2%, 7%, 29%, and 23% for organ-confined, extraprostatic extension, seminal vesicle invasion, and lymph node-positive prostate cancer. Of 3756 patients with organ-confined and Gleason 2–6 cancer, only 1 (0.03%) died from prostate cancer. Primary and secondary Gleason grade (p < 0.001 for both), seminal vesicle invasion (p < 0.001), and year of surgery (p = 0.002) were significant predictors of PCSM. A nomogram predicting 15-year PCSM based on pathologic parameters was accurate and discriminating with an externally-validated concordance index of 0.92. Conclusions: A nomogram has been constructed that predicts the long-term risk of PCSM after radical prostatectomy based on the pathologic grade and stage of the cancer. The presence of poorly differentiated cancer and seminal vesicle invasion are the prime determinants of PCSM. Our study suggests that biomarkers may have limited empiric prognostic utility as PCSM can be accurately predicted once the pathologic features of prostate cancer are known. No significant financial relationships to disclose.

scholarly journals Prostate Cancer–Specific Mortality After Radical Prostatectomy for Patients Treated in the Prostate-Specific Antigen Era

2009 ◽  
Vol 27 (26) ◽  
pp. 4300-4305 ◽  
Author(s):  
Andrew J. Stephenson ◽  
Michael W. Kattan ◽  
James A. Eastham ◽  
Fernando J. Bianco ◽  
Ofer Yossepowitch ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Features ◽  
Specific Antigen ◽  
Clinical Trial Design ◽  
Gleason Grade ◽  
Patient Counseling ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Purpose The long-term risk of prostate cancer–specific mortality (PCSM) after radical prostatectomy is poorly defined for patients treated in the era of widespread prostate-specific antigen (PSA) screening. Models that predict the risk of PCSM are needed for patient counseling and clinical trial design. Methods A multi-institutional cohort of 12,677 patients treated with radical prostatectomy between 1987 and 2005 was analyzed for the risk of PCSM. Patient clinical information and treatment outcome was modeled using Fine and Gray competing risk regression analysis to predict PCSM. Results Fifteen-year PCSM and all-cause mortality were 12% and 38%, respectively. The estimated PCSM ranged from 5% to 38% for patients in the lowest and highest quartiles of predicted risk of PSA-defined recurrence, based on a popular nomogram. Biopsy Gleason grade, PSA, and year of surgery were associated with PCSM. A nomogram predicting the 15-year risk of PCSM was developed, and the externally validated concordance index was 0.82. Neither preoperative PSA velocity nor body mass index improved the model's accuracy. Only 4% of contemporary patients had a predicted 15-year PCSM of greater than 5%. Conclusion Few patients will die from prostate cancer within 15 years of radical prostatectomy, despite the presence of adverse clinical features. This favorable prognosis may be related to the effectiveness of radical prostatectomy (with or without secondary therapy) or the low lethality of screen-detected cancers. Given the limited ability to identify contemporary patients at substantially elevated risk of PCSM on the basis of clinical features alone, the need for novel markers specifically associated with the biology of lethal prostate cancer is evident.

Time to Prostate Specific Antigen Recurrence After Radical Prostatectomy and Risk of Prostate Cancer Specific Mortality

2006 ◽  
Vol 176 (4) ◽  
pp. 1404-1408 ◽  
Author(s):  
Stephen J. Freedland ◽  
Elizabeth B. Humphreys ◽  
Leslie A. Mangold ◽  
Mario Eisenberger ◽  
Alan W. Partin
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Can PSA testing stop 10 years after radical prostatectomy?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 179-179
Author(s):  
S. Loeb ◽  
Z. Feng ◽  
A. Ross ◽  
B. J. Trock ◽  
E. B. Humphreys ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Cancer Specific Survival ◽  
Psa Testing ◽  
Pathologic Features ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Multivariable Models ◽  
The Relationship ◽  
Subsequent Risk

179 Background: Biochemical recurrence (BCR) most frequently occurs within the first five years following radical prostatectomy. Prior studies have suggested an association between lower-risk disease features and BCR at 5 years postoperatively. The objective of our study was to determine predictors of BCR ≥10 years after radical prostatectomy, and to examine the relationship between timing of BCR with the subsequent risk of metastases and cancer-specific mortality. Methods: Among 10,609 men from our institutional radical prostatectomy database, we identified 1684 men with BCR (PSA >0.2 ng/ml) without prior hormonal or radiation therapy. These men were classified into by the time of BCR: early (<5 years), intermediate (5-10 years), and late (>10 years). Univariable and multivariable models were used to examine the association of clinico-pathologic variables with the timing of BCR. We also examined metastasis-free and cancer-specific survival based upon the timing of BCR. Results: Of BCR, 77.0%, 16.6%, 4.9%, and 1.5% occurred at <5, 5-10, 10-15, and >15 years postoperatively. Late recurrences were associated with more favorable pathologic features, and were unlikely to develop metastases or prostate cancer-specific mortality. Conclusions: The majority of BCR occurs within 10 years of surgery. Although 6.4% of BCR occurred at ≥10 years, these patients were unlikely to subsequently develop metastases or die from prostate cancer. Patients who remain free from progression at 10 years postoperatively should be counseled that their risk of subsequent cancer-related morbidity and mortality is low. No significant financial relationships to disclose.

scholarly journals Oncologic Outcome of Radical Prostatectomy as Monotherapy for Men with High-risk Prostate Cancer

2015 ◽  
Vol 9 (2) ◽  
pp. 67-72 ◽  
Author(s):  
Junya Furukawa ◽  
Hideaki Miyake ◽  
Taka-aki Inoue ◽  
Takayoshi Ogawa ◽  
Hirokazu Tanaka ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Seminal Vesicle ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Capsular Invasion ◽  
Seminal Vesicle Invasion ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Background: The objective of this study was to review our experience with radical prostatectomy (RP) as monotherapy for men with high-risk prostate cancer (PCa). Patients and Methods: This study included 382 consecutive patients who were diagnosed with high-risk PCa according to the D'Amico definition and subsequently underwent RP without neoadjuvant therapy. Biochemical recurrence (BR) was defined as a serum prostate-specific antigen (PSA) level ≥ 0.2 ng/ml on two consecutive measurements, and none of the patients received any adjuvant therapies until their serum PSA levels reached ≥ 0.4 ng/ml. Results: The median preoperative serum PSA level in these 382 patients was 15.9 ng/ml. Pathological stages ≥ pT2c and Gleason scores ≥ 8 were observed in 288 and 194 patients, respectively. During the observation period (median, 48.0 months), BR occurred in 134 patients, and the 5-year BR-free survival rate was 60.1%; however, no patient died of cancer progression. Multivariate analysis identified capsular invasion, seminal vesicle invasion, and surgical margin status as independent predictors of BR. Conclusions: Comparatively favorable cancer control could be achieved using RP as monotherapy for men with high-risk PCa; however, RP alone may be insufficient for patients with capsular invasion, seminal vesicle invasion, and/or surgical margin positivity.

Bilateral Lymph Node Micrometastases and Seminal Vesicle Invasion Associated with Same Clinical Predictors in Localized Prostate Cancer

2016 ◽  
Vol 103 (3) ◽  
pp. 299-306 ◽  
Author(s):  
Antonio B. Porcaro ◽  
Nicolò de Luyk ◽  
Paolo Corsi ◽  
Marco Sebben ◽  
Alessandro Tafuri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Seminal Vesicle ◽  
Multinomial Logistic Regression ◽  
Close Association ◽  
Specific Antigen ◽  
Gleason Grade ◽  
Clinical Predictors ◽  
Lymph Node Micrometastases ◽  
Seminal Vesicle Invasion

Aim To determine clinical factors associated with multiple bilateral lymph node micrometastases and seminal vesicle invasion (pT3b) in organ-confined prostate cancer (PCa). Methods The study excluded patients under androgen deprivation, with lymph node involvement (cN1 status), and having undergone unilateral pelvic lymph node dissection (PLND) during radical prostatectomy (RP). Lymph node micrometastases were classified as unilateral (pN1m) and bilateral (pN1b). Analysis considered multivariate multinomial logistic regression models. Results Between January 2013 and March 2015, 140 patients underwent PLND during RP. Lymph node micrometastases were detected in 28 cases (20%) including pN1m in 19 (13.6%) and pN1b in 9 (6.4%). Independent clinical predictors of pN1b included prostate-specific antigen (PSA, µg/L) >12.5 (odds ratio [OR] = 43.0), proportion of positive biopsy cores (PBC) >0.57 (OR = 6.7), and biopsy Gleason grade (bGG) >3 (OR = 7.5). Independent pT3b predictors included PSA>12.5 (OR = 3.8), PBC>0.57 (OR = 4.1), and bGG>3 (OR = 3.8). Conclusions In cN0 patients with localized PCa undergoing PLND, a nonnegligible rate of multiple lymph node micrometastases was detected (32.2%). In the natural history of PCa, there is a close association between pT3b and pN1b disease. Prostate cancer patients who are at high risk of extraglandular extension need selective pelvic staging by multiparametric magnetic resonance imaging to assess seminal vesicle invasion. Operated patients with pT3b and pNx status need close PSA monitoring because of the high probability of occult multiple bilateral lymph node micrometastases.

scholarly journals Time to Prostate-Specific Antigen Nadir After Radical Prostatectomy – a new potential predictive prognostic parameter and its impact on clinical outcomes

2020 ◽  
Author(s):  
Minh Dac Tran ◽  
Kim L Moretti ◽  
Michael E O'Callaghan
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Outcomes ◽  
Competing Risks ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Abstract BackgroundTo investigate and validate previously published associations between time to prostate-specific antigen nadir and the time-to-nadir after radical prostatectomy with biochemical recurrence and to extend this analysis to overall survival and prostate cancer-specific mortality risk. MethodsThis is a retrospective analysis of 1796 men from the South Australian Prostate Cancer Clinical Outcomes Collaborative database treated with radical prostatectomy between 1998-2018 with available prostate-specific antigen nadir data within 1-6 months after surgery. Uni- and multivariable analyses of prostate-specific antigen nadir, time-to-nadir, biochemical recurrence and death were performed with Cox and competing risks models (adjusted for age, surgery year, tumour features and preoperative prostate-specific antigen).ResultsThe univariable analysis demonstrated those with shorter time-to-nadir <3 months had a decreased risk of biochemical recurrence (log-rank, p=0.0098) compared to those with longer time-to-nadir 3-6 months. For men with a time-to-nadir <3 months, a Log-rank test showed a decreased risk of prostate cancer-specific mortality (p=0.026) compared to time-to-nadir 3-6 months, without a difference in overall survival. Multivariable competing risk analyses indicated that biochemical recurrence was more likely when time-to-nadir was 3-6 months compared to <3 months (sHR=1.43, CI 1.01-2.02, p=0.04).ConclusionsAmong men undergoing radical prostatectomy, a shorter post-operative time-to-nadir <3 months is associated with decreased risk of biochemical recurrence compared to time-to-nadir 3-6 months. Following adjustment for confounders and competing risks, there was no significant difference in time-to-nadir for mortality outcomes.

POD-05.08: Predicting the Long-Term Risk of Prostate Cancer-Specific Mortality After Radical Prostatectomy

Urology ◽  
2009 ◽  
Vol 74 (4) ◽  
pp. S16
Author(s):  
A. Stephenson ◽  
M. Kattan ◽  
E. Klein ◽  
S. Eggener ◽  
P. Scardino ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Specific Mortality ◽  
Cancer Specific Mortality
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