Natural history of surgically treated high-risk prostate cancer - Abstract

BACKGROUND: No data exist on the patterns of biochemical recurrence (BCR) and their effect on survival in patients with high-risk prostate cancer (PCa) treated with surgery.

The aim of our investigation was to evaluate the natural history of PCa in patients treated with radical prostatectomy (RP) alone.

MATERIALS AND METHODS: Overall, 2,065 patients with high-risk PCa treated with RP at 7 tertiary referral centers between 1991 and 2011 were identified. First, we calculated the probability of experiencing BCR after surgery. Particularly, we relied on conditional survival estimates for BCR after RP. Competing-risks regression analyses were then used to evaluate the effect of time to BCR on the risk of cancer-specific mortality (CSM).

RESULTS: Median follow-up was 70 months. Overall, the 5-year BCR-free survival rate was 55.2%. Given the BCR-free survivorship at 1, 2, 3, 4, and 5 years, the BCR-free survival rates improved by+7.6%,+4.1%,+4.8%,+3.2%, and+3.7%, respectively. Overall, the 10-year CSM rate was 14.8%. When patients were stratified according to time to BCR, patients experiencing BCR within 36 months from surgery had higher 10-year CSM rates compared with those experiencing late BCR (19.1% vs. 4.4%; P< 0.001). At multivariate analyses, time to BCR represented an independent predictor of CSM (P< 0.001).

CONCLUSIONS: Increasing time from surgery is associated with a reduction of the risk of subsequent BCR. Additionally, time to BCR represents a predictor of CSM in these patients. These results might help provide clinicians with better follow-up strategies and more aggressive treatments for early BCR.

Written by:
Briganti A, Karnes RJ, Gandaglia G, Spahn M, Gontero P, Tosco L, Kneitz B, Chun FK, Zaffuto E, Sun M, Graefen M, Marchioro G, Frohneberg D, Giona S, Karakiewicz PI, Van Poppel H, Montorsi F, Joniau S.   Are you the author?
Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN; Department of Urology, University of Bern, Bern, Switzerland; Department of Urology, University of Turin, Torino, Italy; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology and Pediatric Urology, University Hospital Wurzburg, Wurzburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University of Piemonte Orientale, Novara, Italy; Department of Urology, Community Hospital Karlsruhe, Karlsruhe, Germany.

Reference: Urol Oncol. 2015 Feb 6. pii: S1078-1439(14)00439-6.
doi: 10.1016/j.urolonc.2014.11.018

PubMed Abstract
PMID: 25665508 Prostate Cancer Section