A total of 227 consecutive patients treated with RP, pelvic lymph node dissection and aRT for locally advanced CaP (pT3a/pT3b) and/or positive surgical margins (SM+) between 1988 and 2006 at a single tertiary referral center were studied. All patients experienced BCR; time to BCR and time to cancer-specific mortality (CSM) were computed. Univariate and multivariate models tested the association between predictors (namely, pre-operative PSA, pathological Gleason sum and stage, time to BCR) and CSM.
Mean age at BCR was 65 year and mean PSA at surgery was 26ng/ml. Pathologic Gleason score was 2-6, 7, and 8-10 in 22.4%, 37.9% and 39.7% of patients. Extracapsular extension and seminal vesicle invasion (SVI) were present in 51.8% and 48.2% of patients, respectively. Overall, 35.8% of patients had SM+. CSM-free survival rates at 5 and 10 years after BCR were 81% and 70%, respectively. In multivariate analysis, after adjusting for age, PSA, SVI and RP Gleason sum, the presence of lymph node involvement (HR:23.7, p=0.01) and time to BCR (HR: 0.93, p=0.01) represented independent predictors of CSM. When patients were stratified according to the most informative cut-off for time to BCR (36 months), patients who experienced BCR <36 months after RP had a 3.6 fold increased risk of CSS. He concluded that among patients with PSA failure after adjuvant RT, the presence of lymph node invasion at RP and a time to BCR <3 years may select for the identification of patients suitable for accrual to clinical trials.
Presented by Alberto Briganti, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria