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Clinically high-risk prostate cancer patients comprise a relevant number of cancers with overall favorable tumor characteristics

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Abstract

Purpose

We hypothesized that a relevant number of patients with clinically high-risk prostate cancer (PCA) indeed harbor overall favorable tumor characteristics (OFTC) (i.e., pT2a-c and Gleason score ≤3 + 4 = 7 and pN0/X) and that in these patients radical prostatectomy (RP) alone is most likely curative.

Methods

Between June 1, 1997, and October 31, 2011, 2,346 patients with biopsy-detected PCA underwent RP. According to D’Amico, 1,767 patients presented low-/intermediate-risk PCA, and 579 presented high-risk PCA. We compared the incidence of OFTC between low-/intermediate-risk and high-risk patients, and between high-risk patients with different risk factor constellations. Furthermore, overall survival (OS), cancer-specific survival (CSS) and biochemical progression-free survival (BFS) were calculated for low-/intermediate-risk and high-risk patients with and without OFTC.

Results

High-risk patients were less likely to harbor OFTC (17.3 vs. 58.2 %; p < 0.001). That means, however, that nearly one in five patients with clinically high-risk PCA indeed had OFTC. Particularly, the subgroup with PSA >20 ng/ml or cT2c-3 tumor as sole high-risk factor showed a considerable proportion of OFTC in 30.2 and 26.1 % of cases, respectively. While the entire high-risk group had shorter OS, CSS and BFS than the low-/intermediate-risk group, high-risk patients with OFTC had comparably good OS, CSS and BFS as low-/intermediate-risk patients with OFTC.

Conclusions

Nearly, one in five patients assumed to have high-risk PCA indeed had OFTC. Particularly, patients with PSA >20 ng/ml or cT2c-3 tumor as sole high-risk factor were often misclassified. However, these misclassified patients achieve excellent survival and have a reasonable chance of cure with RP alone.

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Acknowledgments

We would like to thank Ms. M. Vanberg and Ms. A. Pailliart for their help with the data processing and Ms. H. Coleman for revision of the English manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study was approved by local ethics committee and was performed in accordance with the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.

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Authors and Affiliations

  1. Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany

    M. Musch, J. Pluemer, V. Klevecka & D. Kroepfl

  2. Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany

    U. Roggenbuck

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  1. M. Musch
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  2. J. Pluemer
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  3. U. Roggenbuck
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  4. V. Klevecka
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Correspondence to M. Musch.

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Musch, M., Pluemer, J., Roggenbuck, U. et al. Clinically high-risk prostate cancer patients comprise a relevant number of cancers with overall favorable tumor characteristics. World J Urol 33, 85–92 (2015). https://doi.org/10.1007/s00345-014-1274-9

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  • DOI: https://doi.org/10.1007/s00345-014-1274-9

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