Positive surgical margins and biochemical recurrence in obese patients with intermediate- and high-grade prostate cancer with radical prostatectomy.

50 Background: The relationship between obesity and prostate cancer outcomes is unclear. We performed a retrospective cohort study to determine the effect of body mass index (BMI) on a cohort of patients with intermediate to high grade prostate cancer treated with radical prostatectomy (RP). Methods: Our retrospective study cohort included 582 men diagnosed with Gleason 7-10 prostate cancer between 1998 and 2008 and treated with RP at a single institution. Patients were stratified into four groups on the basis of their BMI at the time of prostate cancer diagnosis (<25, 25-30, 30-35 or >35). The primary endpoints for comparison were biochemical failure free survival (BFFS) and the incidence of positive margins. PSA >0.2 ng/dl was used to define biochemical failure. Results: After adjusting for age, Gleason score, pre-treatment PSA and the presence of diabetes, we found patients with increasing BMI had an increased frequency of biochemical failure after RP. Compared to patients with a normal BMI (<25), patients with BMI 25-30, 30-35, and >35 had 1.82 (1.12, 2.97; p = 0.02), 2.14 (1.33, 3.45; p = 0.002) and 2.29 (1.1, 4.78; p = 0.03) times higher rates of biochemical failure, respectively. We additionally found increased positive margins after RP in patients with a BMI 30-35 and >35 (41.4% and 45.5%, respectively) when compared to patients with a BMI of <25 and 25-30 (33.3% and 28.9%, respectively); p = 0.02. Conclusions: Patients with increasing BMI seem to be at significantly increased risk for biochemical failure following RP potentially due to the increased technical difficulty of the surgery and increased incidence of positive margins. [Table: see text]

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Effect of serum testosterone on treatment outcomes in patients with intermediate- to high-grade prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.180 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 180-180

Author(s):

Matthew W. Jackson ◽

Emma Ramahi ◽

Gregory P. Swanson ◽

Joseph W. Basler

Keyword(s):

Prostate Cancer ◽

Treatment Outcomes ◽

Serum Testosterone ◽

Biochemical Failure ◽

Study Cohort ◽

Potential Marker ◽

Primary Endpoints ◽

Increased Risk ◽

Significant Difference ◽

Adenocarcinoma Of The Prostate

180 Background: Low serum testosterone (TS) has been suggested to be a potential marker for more aggressive prostate cancer. However, there are conflicting data regarding whether or not patients with low TS have a higher rate of biochemical recurrence following radical prostatectomy (RP). We evaluated the relationship between postoperative TS and treatment outcomes in patients with Gleason 7–10 adenocarcinoma of the prostate. Methods: Our retrospective study cohort included 462 men diagnosed with Gleason 7–10 prostate cancer who underwent RP between 1998 and 2008 at a single institution. Patients were stratified into five groups on the basis of their postoperative TS percentile within the study cohort (<10th percentile, 10–25, 25–75, 75–90, or >90th percentile). Primary endpoints for comparison were biochemical failure free survival (BFFS) and overall survival (OS). PSA >0.2 ng/dl was used to define biochemical failure. Results: In the study cohort, mean TS was 345.2 ng/dl ± 125.2 and range 107–872 ng/dl. 44 of the 462 men had TS ≤203 ng/dl. This group had a 5-year BFFS of 43% which was significantly worse than all other TS strata (p=0.0017). Range of 5-year BFFS in all other percentile groups was 61.4 – 68.6%. There was no significant difference noted between patients with TS ≥508 ng/dl (>90th percentile) and all other TS strata (p=0.694). Furthermore, no difference in OS was noted among any of the groups (p=0.842). Groups did not differ significantly with respect to age, BMI, presence of diabetes, or known cardiovascular disease. Conclusions: Patients with exceedingly low TS are at significantly increased risk for biochemical failure following RP. Further prospective study is warranted to elucidate interventions that might improve biochemical outcomes in these patients. [Table: see text]

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The Combined Percentage of Gleason Patterns 4 and 5 Is the Best Predictor of Cancer Progression After Radical Prostatectomy

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.018 ◽

2005 ◽

Vol 23 (13) ◽

pp. 2911-2917 ◽

Cited By ~ 75

Author(s):

Liang Cheng ◽

Michael O. Koch ◽

Beth E. Juliar ◽

Joanne K. Daggy ◽

Richard S. Foster ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Gleason Score ◽

Cancer Progression ◽

Tumor Volume ◽

High Grade ◽

Cox Regression Analysis ◽

Total Tumor Volume ◽

Increased Risk

Purpose Clinical outcome is variable in prostate cancer patients treated with radical prostatectomy. The Gleason histologic grade of prostatic adenocarcinoma is one of the strongest predictors of biologic aggressiveness of prostate cancer. We evaluated the significance of the relative proportion of high-grade cancer (Gleason patterns 4 and/or 5) in predicting cancer progression in prostate cancer patients treated with radical prostatectomy. Patients and Methods Radical prostatectomy specimens from 364 consecutive prostate cancer patients were totally embedded and whole mounted. Various clinical and pathologic characteristics were analyzed. All pathologic data, including Gleason grading variables, were collected prospectively. Results A multiple-factor analysis was performed that included the combined percentage of Gleason patterns 4 and 5, Gleason score, tumor stage, surgical margin status, preoperative prostate-specific antigen (PSA), extraprostatic extension, and total tumor volume. Using Cox regression analysis with bootstrap resampling for predictor selection, we identified the combined percentage of Gleason patterns 4 and 5 (P < .0001) and total tumor volume (P = .009) as significant predictors of PSA recurrence. Conclusion The combined percentage of Gleason patterns 4 and 5 is one of the most powerful predictors of patient outcome, and appears superior to conventional Gleason score in identifying patients at increased risk of disease progression. On the basis of our results, we recommend that the combined percentage of Gleason patterns 4 and 5 be evaluated in radical prostatectomy specimens. The amount of high-grade cancer in a prostatectomy specimen should be taken into account in therapeutic decision making and assessment of patient prognosis.

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Risk of death from prostate cancer after radical prostatectomy or brachytherapy in men with low- or intermediate-risk disease.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.198 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 198-198

Author(s):

N. D. Arvold ◽

M. Chen ◽

J. W. Moul ◽

B. J. Moran ◽

D. E. Dosoretz ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Gleason Score ◽

Specific Antigen ◽

Low Risk ◽

Study Cohort ◽

Intermediate Risk ◽

Risk Of Death ◽

Increased Risk ◽

Significant Difference

198 Background: Radical prostatectomy (RP) and brachytherapy (BT) are widely utilized treatments for favorable-risk prostate cancer (PC). We estimated the risk of PC-specific mortality (PCSM) following RP or BT in men with low- or intermediate-risk PC using prospectively collected data. Methods: The study cohort comprised 5,760 men with low-risk PC (prostate-specific antigen [PSA] level ≤ 10 ng/mL, clinical category T1c or 2a, and Gleason score ≤ 6), and 3,079 men with intermediate-risk PC (PSA level 10-20 ng/mL, clinical T2b or T2c, or Gleason score 7). Competing risks multivariable regression was performed to assess risk of PCSM after RP or BT, adjusting for age, treatment year, cardiovascular comorbidity, and known PC prognostic factors. Results: There was no significant difference in the risk of PCSM among men with low-risk PC (11 vs. 6 deaths: adjusted hazard ratio [AHR], 1.62; 95% CI, 0.59–4.45; P = 0.35) who received BT compared to RP. However among men with intermediate-risk PC, despite significantly shorter median follow-up for men undergoing BT as compared to RP (4.1 vs. 7.2 years, P < 0.001), there was a trend toward an increased risk of PCSM (18 vs. 9 deaths: AHR, 2.30; 95% CI, 0.95–5.58; P = 0.07) for men treated with BT. Conclusions: The risk of PCSM among men with low-risk PC was not significantly different following RP or BT, however there may be a reduced risk of PCSM after RP as compared to BT in men with intermediate-risk PC. [Table: see text] No significant financial relationships to disclose.

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5hmC Level Predicts Biochemical Failure Following Radical Prostatectomy in Prostate Cancer Patients with ERG Negative Tumors

International Journal of Molecular Sciences ◽

10.3390/ijms20051025 ◽

2019 ◽

Vol 20 (5) ◽

pp. 1025 ◽

Cited By ~ 2

Author(s):

Gitte Kristensen ◽

Siri Strand ◽

Martin Røder ◽

Kasper Berg ◽

Birgitte Toft ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Assessment ◽

Radical Prostatectomy ◽

Cox Regression ◽

Predictive Biomarker ◽

Biochemical Failure ◽

Regression Analyses ◽

5Hmc Level ◽

Increased Risk

This study aimed to validate whether 5-hydroxymethylcytosine (5hmC) level in combination with ERG expression is a predictive biomarker for biochemical failure (BF) in men undergoing radical prostatectomy (RP) for prostate cancer (PCa). The study included 592 PCa patients from two consecutive Danish RP cohorts. 5hmC level and ERG expression were analyzed using immunohistochemistry in RP specimens. 5hmC was scored as low or high and ERG was scored as negative or positive. Risk of BF was analyzed using stratified cumulative incidences and multiple cause-specific Cox regression using competing risk assessment. Median follow-up was 10 years (95% CI: 9.5–10.2). In total, 246 patients (41.6%) had low and 346 patients (58.4%) had high 5hmC level. No significant association was found between 5hmC level or ERG expression and time to BF (p = 0.2 and p = 1.0, respectively). However, for men with ERG negative tumors, high 5hmC level was associated with increased risk of BF following RP (p = 0.01). In multiple cause-specific Cox regression analyses of ERG negative patients, high 5hmC expression was associated with time to BF (HR: 1.8; 95% CI: 1.2–2.7; p = 0.003). In conclusion, high 5hmC level was correlated with time to BF in men with ERG negative PCa, which is in accordance with previous results.

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Impact of Obesity on Biochemical Control After Radical Prostatectomy for Clinically Localized Prostate Cancer: A Report by the Shared Equal Access Regional Cancer Hospital Database Study Group

Journal of Clinical Oncology ◽

10.1200/jco.2004.04.181 ◽

2004 ◽

Vol 22 (3) ◽

pp. 446-453 ◽

Cited By ~ 290

Author(s):

Stephen J. Freedland ◽

William J. Aronson ◽

Christopher J. Kane ◽

Joseph C. Presti ◽

Christopher L. Amling ◽

...

Keyword(s):

Prostate Cancer ◽

Multivariate Analysis ◽

Radical Prostatectomy ◽

Biochemical Failure ◽

Surgical Margins ◽

Failure Rates ◽

Data Set ◽

Positive Surgical Margins ◽

Increased Risk ◽

The Impact

Purpose Given the limited information regarding the impact of obesity on treatment outcomes for prostate cancer, we sought to examine the relationship between body mass index (BMI) and cancer control after radical prostatectomy (RP). Patients and Methods We compared clinicopathologic and biochemical outcome information across BMI groups from 1,106 men treated with RP between 1988 and 2002. Multivariate analysis was used to determine if BMI significantly predicted adverse pathology or biochemical recurrence. Results Obesity was related to year of surgery (P < .001) and race (P < .001), with black men having the highest obesity rates. Obese patients had higher biopsy and pathologic grade tumors (P < .001). On multivariate analysis, BMI ≥ 35 kg/m2 was associated with a trend for higher rates of positive surgical margins (P = .008). Overweight patients (BMI, 25 to 30 kg/m2) had a significantly decreased risk of seminal vesicle invasion (P = .039). After controlling for all preoperative clinical variables including year of surgery, BMI ≥ 35 kg/m2 significantly predicted biochemical failure after RP (P = .002). After controlling for surgical margin status, BMI ≥ 35 kg/m2 remained a significant predictor of biochemical failure (P = .012). There was a trend for BMI ≥ 35 kg/m2 to be associated with higher failure rates than BMI between 30 and 35 kg/m2 (P = .053). Conclusion The percentage of obese men undergoing RP in our data set doubled in the last 10 years. Obesity was associated with higher-grade tumors, a trend toward increased risk of positive surgical margins, and higher biochemical failure rates among men treated with RP. A BMI ≥ 35 kg/m2 was associated with a higher risk of failure than a BMI between 30 and 35 kg/m2.

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