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Abstract

Volume 19, Issue 6 (November 2017) 19, 700–706; 10.4103/1008-682X.193569

Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy

Jeong Hee Hong1, 2, Young Suk Kwon1, Isaac Yi Kim1

1 Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ 08903, USA
2 Department of Urology, Dankook University, College of Medicine, Cheonan 31116, South Korea

Correspondence: Dr. IY Kim (kimiy@cinj.rutgers.edu)

Date of Submission 13-Jul-2016 Date of Decision 19-Sep-2016 Date of Acceptance 01-Nov-2016 Date of Web Publication 21-Feb-2017

Abstract

The aim of this study is to identify optimal patients for adjuvant radiation therapy (ART) in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy (RP) has been demonstrated, but over- or under-treatment remains a significant concern. Two-hundred and five patients with pT3N0M0 who underwent robot-assisted RP without ART were analyzed. Multivariate Cox proportional regression analyses were used to identify predictors of biochemical recurrence (BCR) and clinical progression (CP). The estimated 5-year BCR-free survival (BCRFS) and CP-free survival (CPFS) were 52.8% and 85.6%, respectively. Preoperative prostate-specifc antigen (PSA) ≥10 ng ml−1 (hazard ratio [HR]: 3.288-6.027; P = 0.003), pathologic Gleason score (pGS) ≥8 (HR: 4.146; P = 0.014), and lymphovascular invasion (LVI) (HR: 2.167; P = 0.026) were associated with BCR. Based on these factors, a risk stratification tool was developed. Patients with no risk factors (PSA <10 ng ml−1 , pGS 6, and absent LVI) showed excellent BCRFS and CPFS at 5 years (91.9% and 100.0%, respectively), but those with two or more risk factors (PSA ≥10 ng ml−1 , pGS ≥8, or present LVI) had poor BCRFS and CPFS (12.1% and 54.6%, respectively). In addition, the multivariate analysis revealed that pathologic stage pT3b (HR: 5.393; P = 0.025) was the only predictor of CP. Our study demonstrated the heterogeneity of oncologic outcomes in patients with pT3 prostate cancer. The proposed risk stratification can be used to identify patients who are at risk for disease progression and may aid in identifying the best patients for ART.

Keywords: prostatectomy; prostate-specific antigen; recurrence; survival

Keywords: prostatectomy; prostate-specific antigen; recurrence; survival

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