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Improved decision making in intermediate-risk prostate cancer: a multicenter study on pathologic and oncologic outcomes after radical prostatectomy

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Abstract

Background

Prognoses for intermediate-risk prostate cancer (PCa) remain heterogeneous. Improved substratification could optimize treatment and monitoring strategies. The objective was to validate this subclassification in a radical prostatectomy (RP) series.

Methods

Between 2000 and 2011, 4038 patients who underwent RP for intermediate-risk PCa in seven French academic centers were included. Unfavorable intermediate-risk (UIR) PCa was defined as having a primary Gleason score of 4, ≥50% positive biopsy cores (PPBC), or more than one D’Amico intermediate-risk factor (i.e., cT2b, PSA 10–20, or Gleason score 7). Remaining PCa cases were classified as favorable. Main endpoints were pathologic results (pT stage, final Gleason score, surgical margin status), and oncologic outcomes were assessed according to PSA recurrence-free survival (PSA-RFS). Univariate and multivariate analyses were performed using the log-rank test and the Cox proportional hazards model.

Results

Median follow-up was 48 months (95% CI = [45–49]). Patients with UIR had worse PSA-RFS (68.17 vs. 81.98% at 4 years, HR = 1.97, 95% CI = [1.71; 2.27], p < 0.0001) compared to those with a favorable disease. The need for adjuvant therapy was significantly greater for UIR patients (43.5 vs. 29.2%, p < 0.0001). In multivariate analysis, primary Gleason score of 4 (HR = 1.81, 95% CI = [1.55; 2.12], p < 0.0001) and PPBC ≥ 50% (HR = 1.26, 95% CI = [1.02; 1.56], p = 0.0286) were significant preoperative predictors for worse PSA-RFS.

Conclusions

This study highlights the heterogeneity of NCCN intermediate-risk patients and validates (in a large RP cohort) the previously proposed subclassification for this group. This classification can significantly predict both pathologic and oncologic outcomes. This easy-to-use stratification could help physicians’ decision making. Prospective study and new tools as genomic tests and novel molecular-based approaches can improve this stratification in the future for patient counseling.

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Authors’ contribution

Beauval and Ploussard have contributed to protocol/project development, data collection or management, data analysis, and manuscript writing/editing. Cabarrou has contributed to data analysis. Roumiguié and Ouzzane have contributed to data collection or management, protocol/project development. Gas, Goujon, Marcq, and Mathieu have contributed to data collection or management. Vincendeau, Cathelineau, and Salomon have contributed to manuscript writing/editing, data collection or management. Soulié, de La Taille, and Rouprêt have contributed to manuscript writing/editing. Rozet has contributed to manuscript writing/editing, protocol/project development.

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Authors and Affiliations

  1. Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France

    Jean Baptiste Beauval, Mathieu Roumiguié, Jérome Gas & Michel Soulié

  2. Department of Urology, Clinique St Jean du Languedoc, Toulouse, France

    Guillaume Ploussard

  3. Institut Claudius Regaud, IUCT-O, 31059, Toulouse, France

    Jean Baptiste Beauval, Guillaume Ploussard, Bastien Cabarrou, Mathieu Roumiguié & Michel Soulié

  4. Department of Urology, Andrology and Renal Transplantation, CHU Lille, Lille, France

    Adil Ouzzane & Gautier Marcq

  5. Department of Urology, Andrology and Renal Transplantation, CHU Rennes, Rennes, France

    Romain Mathieu & Sébastien Vincendeau

  6. Department of Urology, Institut Mutualiste Monsouris, Paris-Descartes University, Paris, France

    Annabelle Goujon, Xavier Cathelineau & François Rozet

  7. Department of Urology, Andrology and Renal Transplantation Hôpital Saint-Louis, Paris-7 Denis Diderot University, Paris, France

    Pierre Mongiat-Artus

  8. Department of Urology, Andrology and Renal Transplantation, CHU Mondor, Créteil, France

    Laurent Salomon & Alexandre de La Taille

  9. Department of Urology and Renal transplantation, HEGP, Paris, France

    Arnaud Méjean

  10. Department of Urology, Andrology and Renal Transplantation, CHU La Pitié Salpétrière, Paris, France

    Morgan Rouprêt

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  1. Jean Baptiste Beauval
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  2. Guillaume Ploussard
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  3. Bastien Cabarrou
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  4. Mathieu Roumiguié
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  6. Jérome Gas
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  7. Annabelle Goujon
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  11. Xavier Cathelineau
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  12. Pierre Mongiat-Artus
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  13. Laurent Salomon
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  14. Michel Soulié
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  15. Arnaud Méjean
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  16. Alexandre de La Taille
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  17. Morgan Rouprêt
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  18. François Rozet
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Consortia

Committee of Cancerology of the Association of French Urology

Corresponding author

Correspondence to Jean Baptiste Beauval.

Ethics declarations

This study was performed in accordance with ethical standards.

Conflict of interest

The authors declare no conflicts of interest.

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Beauval, J.B., Ploussard, G., Cabarrou, B. et al. Improved decision making in intermediate-risk prostate cancer: a multicenter study on pathologic and oncologic outcomes after radical prostatectomy. World J Urol 35, 1191–1197 (2017). https://doi.org/10.1007/s00345-016-1979-z

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  • DOI: https://doi.org/10.1007/s00345-016-1979-z

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