Extent of extraprostatic extension independently influences biochemical recurrence-free survival: Evidence for further pT3 subclassification - Abstract

OBJECTIVE: To evaluate the impact of the extent of extraprostatic extension (EPE) on biochemical recurrence-free survival (BCRFS) after radical prostatectomy (RP).

MATERIALS AND METHODS: We queried our RP database from 2004 to 2013. Extent of EPE on RP was divided into 3 groups: no EPE, focal EPE (F-EPE; a few extraprostatic cancer glands on 1-2 slides), and nonfocal EPE (NF-EPE). Multivariate Cox proportional hazard models determined the influence of EPE on BCRFS.

RESULTS: A total of 10,750 men underwent RP during the study period. Of these, 7843 men (73.0%) had no EPE, 1258 (11.7%) men had F-EPE, and 1649 men had (15.3%) NF-EPE. Overall BCRFS was worse in men with NF-EPE than those with F-EPE or no EPE. In a multivariate model, F-EPE and NF-EPE were both independently associated with worse BCRFS compared with no EPE (F-EPE: hazard ratio, 2.41; 95% confidence interval, 1.84-3.10; P < .0001; NF-EPE: hazard ratio, 3.57; 95% confidence interval, 2.89-4.40; P < .0001). When stratified by Gleason score in men without seminal vesicle invasion or lymph node metastases, there was no difference in BCRFS for Gleason score < 6, 3 + 4 = 7, 4 + 3 = 7, and 8 for F-EPE vs no EPE; however, patients with Gleason score of 9-10 with F-EPE had worse BCRFS. Patients with NF-EPE had significantly worse BCRFS for Gleason score < 6, 7, and 8 and a trend for worse BCRFS for Gleason score 9-10 compared with no EPE.

CONCLUSION: Although all men with EPE have higher BCRFS after RP, men with NF-EPE have worse BCRFS than those with F-EPE, supporting the need to substratify pT3a prostate cancer in the American Joint Committee on Cancer staging system.

Written by:
Ball MW, Partin AW, Epstein JI.   Are you the author?
Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD; Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD; Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD.  

Reference: Urology. 2015 Jan;85(1):161-4.
doi: 10.1016/j.urology.2014.08.025

PubMed Abstract
PMID: 25440818

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