Identification of curable high-risk prostate cancer using radical prostatectomy alone: who are the good candidates for undergoing radical prostatectomy among patients with high-risk prostate cancer?

Currently, there is no consensus regarding which patients with high-risk prostate cancer (PCa) would benefit the most by radical prostatectomy (RP). We aimed to identify patients with high-risk PCa who are treatable by RP alone.

We retrospectively reviewed data on 315 patients with D'Amico high-risk PCa who were treated using RP without neoadjuvant or adjuvant therapy at the institutions of the Yamaguchi Uro-Oncology Group between 2009 and 2013. The primary endpoint was biochemical progression-free survival (bPFS) after RP. Risk factors for biochemical progression were extracted using the Cox proportional hazard model. We stratified the patients with high-risk PCa into 3 subgroups based on bPFS after RP using the risk factors.

At a median follow-up of 49.9 months, biochemical progression was observed in 20.5% of the patients. The 2- and 5-year bPFS after RP were 89.4 and 70.0%, respectively. On multivariate analysis, Gleason score (GS) at biopsy (≥ 8, HR 1.92, p < 0.05) and % positive core (≥ 30%, HR 2.85, p < 0.005) were independent predictors of biochemical progression. Patients were stratified into favorable- (0 risk factor; 117 patients), intermediate- (1 risk factor; 127 patients), and poor- (2 risk factors; 57 patients) risk groups, based on the number of predictive factors. On the Cox proportional hazard model, this risk classification model could significantly predict biochemical progression after RP (favorable-risk, HR 1.0; intermediate-risk, HR 2.26; high-risk, HR 5.03; p < 0.0001).

The risk of biochemical progression of high-risk PCa after RP could be stratified by GS at biopsy (≥ 8) and % positive core (≥ 30%).

International journal of clinical oncology. 2018 Mar 27 [Epub ahead of print]

Kazuhiro Nagao, Hideyasu Matsuyama, Hiroaki Matsumoto, Takahito Nasu, Mitsutaka Yamamoto, Yoriaki Kamiryo, Yoshikazu Baba, Akinobu Suga, Yasuhide Tei, Satoru Yoshihiro, Akihiko Aoki, Tomoyuki Shimabukuro, Keiji Joko, Shigeru Sakano, Kimio Takai, Shiro Yamaguchi, Jumpei Akao, Seiji Kitahara, Yamaguchi Uro-Oncology Group

Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, 755-8505, Japan. ., Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, 755-8505, Japan., Department of Urology and Nephrology, Tokuyama Central Hospital, 1-1 Takada, Shunan, 745-8522, Japan., Department of Urology, Yamaguchi Grand Medical Center, 77 Osaki, Hofu, Yamaguchi, 747-8511, Japan., Department of Urology, Shimonoseki Saisekai Toyoura Hospital, 7-3 Kogushi, Toyoura, Shimonoseki, 759-6302, Japan., Department of Urology, Shuto General Hospital, 1000-1 Kogaisaku, Yanai, 742-0032, Japan., Department of Urology, Yamaguchi Red Cross Hospital, 53-1 Hachimanbaba, Yamaguchi, 753-8519, Japan., Department of Urology, Kanmon Medical Center, 1-1-1 Chofusotoura-cho, Shimonoseki, 752-8510, Japan., Department of Urology, Shimonoseki City Hospital, 1-13-1 Koyo, Shimonoseki, 750-8520, Japan., Department of Urology, Masuda Red Cross Hospital, I 103-1 Otoyoshi-chou, Masuda, 698-8501, Japan., Department of Urology, Saiseikai Yamaguchi General Hospital, 2-11 Midorimachi, Yamaguchi, 753-0078, Japan., Department of Urology, Kokura Memorial Hospital, 3-2-1 Asano, Kokura-ku, Kitakyusyu, Fukuoka, 802-8555, Japan., Department of Urology, Saiseikai Shimonoseki General Hospital, 8-5-1 Yasuoka, Shimonoseki, 759-6603, Japan., Department of Urology, Shimonoseki Medical Center, 3-3-8 Kamishinchi-cho, Shimonoseki, 750-0061, Japan., Department of Urology, Ogori Daiichi General Hospital, 862-3 Ogori Shimogo, Yamaguchi, 754-0002, Japan., Department of Urology, Sanyo-Onoda Municipal Hospital, 1863-1 Higashi-Takadomari, Sanyo-Onoda, Yamaguchi, 756-0094, Japan.