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

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

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).

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.

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.

Written by
Lodde M, Harel F, Lacombe L, Fradet Y.

Reference
World J Urol. 2008 Mar 28. Epub ahead of print.
doi:10.1007/s00345-008-0252-5

PubMed Abstract
PMID:18369635

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