Risk factors for clinical metastasis in men undergoing radical prostatectomy and immediate adjuvant androgen deprivation therapy - Abstract

BACKGROUND: Adjuvant androgen deprivation therapy (ADT) is a treatment option for prostate cancer (PC) patients after radical prostatectomy (RP).

Although it can achieve a good progression-free survival rate, some patients still develop clinical metastasis. We here investigated risk factors of clinical metastasis in post- prostatectomy patients who received immediate adjuvant ADT.

MATERIALS AND METHODS: We identified 197 patients with non-metastatic PC who underwent RP at our institution between 2000 and 2012, followed by adjuvant ADT. The associations of various clinicopathologic factors with clinical metastasis (primary endpoint) and cancer-specific survival (secondary endpoint) were assessed. Multivariate analysis was conducted using a Cox proportional hazards model. Median follow-up was 87 months after RP.

RESULTS: Nine (4.6%) patients developed clinical metastasis and six (3.0%) died from PC. Eight of nine metastatic patients had a pathologic Gleason score (GS) 9 and developed bone metastasis, while the remaining one had pathologic GS 7 and developed metastasis only to para-aortic lymph nodes. On multivariate analyses, pathologic GS ≥9 and regional lymph node metastasis (pN1) were independent predictors of clinical metastasis and pathologic GS ≥9 was an independent predictor of cancer-specific death.

CONCLUSIONS: Pathologic GS ≥9 and pN1 were independent predictors of clinical metastasis in post-prostatectomy patients who received immediate adjuvant ADT. Furthermore, pathologic GS ≥9 was an indispensable condition for bone metastasis, which may imply that patients with GS ≤ 8 on adjuvant ADT are unlikely to develop bone metastasis.

Written by:
Taguchi S, Fukuhara H, Kakutani S, Takeshima Y, Miyazaki H, Suzuki M, Fujimura T, Nakagawa T, Igawa Y, Kume H, Homma Y.   Are you the author?
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.  

Reference: Asian Pac J Cancer Prev. 2014;15(24):10729-33.

PubMed Abstract
PMID: 25605166

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