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The number of risk factors is the strongest predictor of prostate cancer mortality: multi-institutional outcomes of an extreme-risk prostate cancer cohort

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Abstract

Purpose

To report treatment outcomes in a cohort of extreme-risk prostate cancer patients and identify a subgroup of patients with worse prognosis.

Materials and methods

Extreme-risk prostate cancer patients were defined as patients with at least one extreme-risk factor: stage cT3b–cT4, Gleason score 9–10 or PSA > 50 ng/ml; or patients with 2 or more high-risk factors: stage cT2c–cT3a, Gleason 8 and PSA > 20 ng/ml. Overall survival (OS), cause-specific survival (CSS), clinical-free survival (CFS), and biochemical non-evidence of disease (bNED) survival are the four outcomes of interest in a population of 1341 patients.

Results

With a median follow-up of 71.5 months, 5- and 10-year bNED survival, CFS, CSS and OS for the entire cohort were 77.1 % and 57.0, 89.2 and 78.9 %, 97.4 and 93.6 %, and 92.0 and 71.3 %, respectively. On multivariate analysis, PSA and clinical stage were associated with bNED survival. PSA and Gleason score predicted for CFS, whereas only Gleason score predicted for OS. When a simplified model was performed using the “number of risk factors” variable, this model provided the best distinction between patients with ≥2 extreme-risk factors and patients with 2 high-risk factors, showing a hazard ratio (HR) of 1.737 (p = 0.0003) for bNED survival, HR 1.743 (p = 0.0448) for OS and an HR of 3.963 (p = 0.0039) for the CSS endpoint.

Conclusions

Patients presenting at diagnosis with two extreme-risk criteria have almost fourfold higher risk for prostate cancer mortality. Such patients should be considered for more aggressive multimodal treatments.

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Acknowledgments

We thank the patients who accepted to participate in this study for their dedication and the study-site staff who cared for them.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Hospital Universitario Cruces, Plaza Cruces Gurutzeta 12, 48903, Barakaldo, Spain

    A. Gomez-Iturriaga

  2. Department of Radiation Oncology, Hospital Doce de Octubre, Madrid, Spain

    Á. Cabeza

  3. Department of Radiation Oncology, Hospital General de Valencia, Valencia, Spain

    J. Pastor

  4. Department of Radiation Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain

    J. Jove

  5. Department of Radiation Oncology, Instituto Valenciano de Oncologia, Valencia, Spain

    M. Casaña & J. Mengual

  6. Department of Radiation Oncology, Hospital Clínico Universitario, Santiago de Compostela, Spain

    A. G. Caamaño

  7. Department of Radiation Oncology, Hospital Universitario San Joan, Reus, Tarragona, Spain

    I. Henríquez

  8. Department of Radiation Oncology, Hospital Infanta Cristina, Badajoz, Spain

    J. Muñoz

  9. Department of Radiation Oncology, Hospital Ramón y Cajal, Madrid, Spain

    A. Hervás

  10. Department of Radiation Oncology, Hospital Gregorio Marañon, Madrid, Spain

    C. G.-S. Segundo

Authors
  1. A. Gomez-Iturriaga
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  2. Á. Cabeza
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  3. J. Pastor
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  4. J. Jove
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  7. J. Mengual
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  8. I. Henríquez
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  10. A. Hervás
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  11. C. G.-S. Segundo
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Corresponding author

Correspondence to A. Gomez-Iturriaga.

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Conflict of interest

The authors state that they have no relationships, conditions or circumstances that present potential conflicts of interest with this study.

Informed consent

Informed consent was obtained from all live individual participants included in the study.

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Cite this article

Gomez-Iturriaga, A., Cabeza, Á., Pastor, J. et al. The number of risk factors is the strongest predictor of prostate cancer mortality: multi-institutional outcomes of an extreme-risk prostate cancer cohort. Clin Transl Oncol 18, 1026–1033 (2016). https://doi.org/10.1007/s12094-016-1481-5

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  • DOI: https://doi.org/10.1007/s12094-016-1481-5

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