AUA 2018: Who Dies from Prostate Cancer? A Comprehensive Analysis of a Large Series of Patients Treated with Radical Prostatectomy with Long-Term Follow-Up

San Francisco, CA ( Although radical prostatectomy (RP) is associated with excellent oncologic outcomes in prostate cancer (PCa) patients, a significant proportion of patients would ultimately die from the disease itself. Data on disease characteristics of patients who die from PCa are scarce. Therefore, the authors sought to describe the features of these patients.

The authors analyzed 9700 PCa patients who underwent RP and extended pelvic lymph node dissection at a tertiary center.  Cancer-specific mortality (CSM), clinical recurrence (CR) after RP, were analyzed. The authors focused on patients who died from PCa (n=190). Clinical and pathologic characteristics, as well as time from surgery to CR and from CR to CSM, were analyzed.

Of all 190 men who died from PCa, 54 (28.4%), 44 (23.2%) and 45 (23.7%) patients had biopsy Gleason score (GS) 6, 7 and 8-10, and 105 (55.2%) had clinical T2/T3 stage. Median PSA at RP was 16 ng/ml. Overall, 23 (12.1%), 28 (14.7%), 113 (59.4%) and 26 (13.7%) had pT2, pT3a, pT3b and pT4 stages. Additionally, 47 (24.7%), 43 (22.6%) and 100 (52.6%) harboured GS 6, 7 and 8-10. Of these, 20/ 47 (42%), 27/43 (67%), 57/100 (57%) received neo-adjuvant ADT. Interestingly, 15 patients (7.9%) had pT2pN0, negative surgical margin of whom 13 had GS 7. Only 5 of these 15 received neo-adjuvant ADT. Overall, 122 (64.2%) patients had pN1 disease. Of all men dying from PCa, bone was the most common site of CR (50.9%), followed by pelvic nodes (16.4%), prostatic fossa (15.5%), retroperitoneal nodes (5.1%) and visceral organs (8.6%). Median overall-free survival was 61.2 months. Median time from RP to CR and from CR to CSM was 38 (IQR: 16-46) and 21 months (IQR: 7- 42). Patients with visceral metastases exhibited the shortest median time from CR to CSM (18 months), followed by men with prostatic fossa recurrence (21 months), pelvic lymph node (22 months) and bone metastases (23 months).

In conclusion, the majority of patients who die from PCa showed locally advanced, pN1, high GS PCa with early bone recurrence. Interestingly, 10% of men dying from PCa harbored localized, organ confined disease at RP and roughly 15% of men recurred firstly in the fossa. These results highlight the need for biological classification of lethal PCa.

Presented by: Nazareno Suardi, MD Vita-Salute San Raffaele University, Milan, Italy 
Co-Authors: Nicola Fossati, Giorgio Gandaglia, Paolo Dell'Oglio, Armando Stabile, Emanuele Zaffuto, Carlo Andrea Bravi, Elio Mazzone, Fabio Muttin, Manuela Tutolo, Federico Dehò, Milan, Italy, Rocco Damiano, Catanzaro, Italy, Firas Abdollah, Detroit, MI, Pierre I. Karakiewicz, Montreal, Canada, Francesco Montorsi, Alberto Briganti, Milan, Italy

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA