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Substratification of high-risk localised prostate cancer treated by radical prostatectomy

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Abstract

Aim

To evaluate the clinical outcome of high-risk prostate cancer (PC) treated by radical prostatectomy (RP) according to risk factors.

Methods

Patients with stage cT1–T3 PC were stratified in high and low/intermediate risk groups using D’Amico’s criteria: PSA ≥20 ng/ml or Gleason score ≥8 or clinical stage ≥T2c. The Kaplan Meier and Log rank test were used to generate estimates of biochemical free-survival (BFS) and PC specific mortality (PCSM).

Results

We analysed 1,109 patients with a median age of 64.1 years, a mean PSA of 12.8 and a median follow-up of 8.18 years (max. 17.5 years). Overall PSA failures (PSAF) were observed in 23.4%, mortality by all causes in 11.4% and PCSM in 2.9%. The 10-year BFS of the 290 high-risk was 45 versus 75.5% for low/intermediate risk patients and the 10-year PCSM was 10.3 versus 1.4%, respectively. Of the 290 high-risk PC, 25% had organ-confined disease at surgery with 28% PSAF compared to 55% PSAF for non-organ-confined PC irrespective of nodal status. High-risk patients with 1 or ≥2 high risk criteria had 2.6 and 3.86 times increased risk of PSAF compared to low/intermediate risk. Ten-year PCSM for PC individual risk criteria was 4.5% for PSA ≥20, 9.2% for stage ≥T2c and 18.2% for Gleason ≥8.

Conclusion

Patients with high-risk PC treated by RP by experienced surgeons can have a favourable long-term survival. Further substratification should take into account the variable prognostic implication of the different individual risk factors.

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Authors and Affiliations

  1. Laval University Cancer Research Center, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, 11, Cote du Palais, Québec, Canada, G1R 2J6

    Michele Lodde, François Harel, Louis Lacombe & Yves Fradet

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  1. Michele Lodde
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  2. François Harel
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  3. Louis Lacombe
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  4. Yves Fradet
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Correspondence to Yves Fradet.

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Lodde, M., Harel, F., Lacombe, L. et al. Substratification of high-risk localised prostate cancer treated by radical prostatectomy. World J Urol 26, 225–229 (2008). https://doi.org/10.1007/s00345-008-0252-5

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  • DOI: https://doi.org/10.1007/s00345-008-0252-5

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