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Prognostication in Lymph Node-Positive Prostate Cancer with No PSA Persistence After Radical Prostatectomy

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to create a prognostic model to predict disease recurrence among patients with lymph node involvement but no prostate-specific antigen (PSA) persistence and to explore its clinical utility.

Methods

The study analyzed patients with lymph node involvement after pelvic lymph node dissection with radical prostatectomy in whom no PSA persistence was observed between 2006 and 2019 at 33 institutions. Prognostic factors for recurrence-free survival (RFS) were analyzed by the Cox proportional hazards model.

Results

Among 231 patients, 127 experienced disease recurrence. The factors prognostic for RFS were PSA level at diagnosis (≥ 20 vs. < 20 ng/mL: hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.09–2.52; P = 0.017), International Society of Urological Pathology grade group at radical prostatectomy (RP) specimen (group ≥ 4 vs. ≤ 3: HR, 1.63; 95% CI 1.12–2.37; P = 0.010), pathologic T-stage (pT3b/4 vs. pT2/3a: HR, 1.70; 95% CI 1.20–2.42; P = 0.0031), and surgical margin status (positive vs. negative: HR, 1.60; 95% CI 1.13–2.28; P = 0.0086). The prognostic model using four parameters were associated with RFS and metastasis-free survival.

Conclusion

The prognostic model in combination with postoperative PSA value and number of lymph nodes is clinically useful for discussing treatment choice with patients.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Urology, Kyushu University, Fukuoka, Japan

    Masaki Shiota MD, PhD, Dai Takamatsu MD, PhD & Masatoshi Eto MD, PhD

  2. Department of Urology, National Cancer Center Hospital, Tokyo, Japan

    Yoshiyuki Matsui MD, PhD

  3. Department of Urology, Harasanshin Hospital, Fukuoka, Japan

    Akira Yokomizo MD, PhD

  4. Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan

    Shuichi Morizane MD, PhD

  5. Department of Urology and Andrology, Kansai Medical University, Osaka, Japan

    Ryoichi Saito MD, PhD

  6. Department of Urology, Nara Medical University, Kashihara, Japan

    Makito Miyake MD, PhD

  7. Department of Urology, Hitachi General Hospital, Hitachi, Japan

    Masakazu Tsutsumi MD, PhD

  8. Department of Urology, Osaka International Cancer Institute, Osaka, Japan

    Yoshiyuki Yamamoto MD, PhD

  9. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Kojiro Tashiro MD, PhD & Takahiro Kimura MD, PhD

  10. Department of Urology, Shikoku Cancer Center, Matsuyama, Japan

    Ryotaro Tomida MD

  11. Department of Urology, Akita University, Akita, Japan

    Shintaro Narita MD, PhD

  12. Department of Urology, Okayama University, Okayama, Japan

    Kohei Edamura MD, PhD

  13. Department of Urology, Kumamoto University, Kumamoto, Japan

    Takahiro Yamaguchi MD, PhD

  14. Department of Urology, Sapporo Medical University, Sapporo, Japan

    Kohei Hashimoto MD, PhD

  15. Department of Urology, Nagoya University, Nagoya, Japan

    Masashi Kato MD, PhD

  16. Division of Urology, Department of Regenerative and Transplant Medicine, Niigata University, Niigata, Japan

    Takashi Kasahara MD, PhD

  17. Department of Urology, University of Tsukuba, Tsukuba, Japan

    Takayuki Yoshino MD, PhD

  18. Department of Urology, Kyoto University, Kyoto, Japan

    Shusuke Akamatsu MD, PhD

  19. Department of Urology, Teikyo University School of Medicine, Tokyo, Japan

    Tomoyuki Kaneko MD, PhD

  20. Department of Urology, Kashiwa Hospital, The Jikei University, Chiba, Japan

    Akihiro Matsukawa MD

  21. Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan

    Ryuji Matsumoto MD, PhD

  22. Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan

    Akira Joraku MD, PhD

  23. Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan

    Toshihiro Saito MD, PhD

  24. Department of Urology, Kagawa University, Kagawa, Japan

    Takuma Kato MD, PhD

  25. Department of Nephro-Urologic Surgery and Andrology, Mie University, Tsu, Japan

    Manabu Kato MD, PhD

  26. Department of Urology, Kagoshima University, Kagoshima, Japan

    Hideki Enokida MD, PhD

  27. Department of Urology, Chiba University, Chiba, Japan

    Shinichi Sakamoto MD, PhD

  28. Department of Urology, Miyazaki University, Miyazaki, Japan

    Naoki Terada MD, PhD

  29. Department of Urology, Yamagata University, Yamagata, Japan

    Hidenori Kanno MD, PhD

  30. Department of Urology, University of Toyama, Toyama, Japan

    Naotaka Nishiyama MD, PhD & Hiroshi Kitamura MD, PhD

Authors
  1. Masaki Shiota MD, PhD
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  2. Dai Takamatsu MD, PhD
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  3. Yoshiyuki Matsui MD, PhD
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  4. Akira Yokomizo MD, PhD
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  5. Shuichi Morizane MD, PhD
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  6. Ryoichi Saito MD, PhD
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  7. Makito Miyake MD, PhD
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  8. Masakazu Tsutsumi MD, PhD
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  9. Yoshiyuki Yamamoto MD, PhD
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  10. Kojiro Tashiro MD, PhD
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  11. Ryotaro Tomida MD
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  12. Shintaro Narita MD, PhD
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  13. Kohei Edamura MD, PhD
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  14. Takahiro Yamaguchi MD, PhD
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  15. Kohei Hashimoto MD, PhD
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  16. Masashi Kato MD, PhD
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  17. Takashi Kasahara MD, PhD
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  18. Takayuki Yoshino MD, PhD
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  19. Shusuke Akamatsu MD, PhD
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  20. Tomoyuki Kaneko MD, PhD
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  21. Akihiro Matsukawa MD
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  22. Ryuji Matsumoto MD, PhD
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  23. Akira Joraku MD, PhD
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  24. Toshihiro Saito MD, PhD
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  25. Takuma Kato MD, PhD
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  26. Manabu Kato MD, PhD
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  27. Hideki Enokida MD, PhD
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  28. Shinichi Sakamoto MD, PhD
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  29. Naoki Terada MD, PhD
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  30. Hidenori Kanno MD, PhD
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  31. Naotaka Nishiyama MD, PhD
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  32. Takahiro Kimura MD, PhD
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  33. Hiroshi Kitamura MD, PhD
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  34. Masatoshi Eto MD, PhD
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Consortia

the Japanese Urological Oncology Group

Corresponding author

Correspondence to Masaki Shiota MD, PhD.

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Disclosure

Dr. Akira Yokomizo received lecture fees from Astellas, Bayer, and Janssen Pharma. The remaining authors have no conflicts of interest.

Ethics approval

The study protocol was approved by the institutional review board of each institute.

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Shiota, M., Takamatsu, D., Matsui, Y. et al. Prognostication in Lymph Node-Positive Prostate Cancer with No PSA Persistence After Radical Prostatectomy. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-14999-2

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  • DOI: https://doi.org/10.1245/s10434-024-14999-2

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