BACKGROUND: Phenotype of prostate cancer at diagnosis has changed through the years.
We aim to evaluate the impact of year of surgery on clinical, pathologic and oncologic outcomes of high-risk prostate cancer patients.
PATIENTS AND METHODS: We evaluated 1,033 clinically high-risk patients, defined as the presence of at least one of the following risk factors: pre-operative prostate specific antigen (PSA) level >20 ng/ml, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single Institution. Year-per-year trends of clinical and pathologic characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncologic outcomes.
RESULTS: We observed a decrease over time in the proportion of high-risk patients with a pre-operative PSA level >20 ng/ml or clinical stage cT3. An opposite trend was seen for biopsy Gleason score ≥8. We observed a considerable increase in the median number of lymph nodes removed that was associated with an increased rate of LNI. At multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (HR per 5-year: 0.90; 95% CI: 0.84-0.96; p=0.01) and distant metastasis (HR per 5-year: 0.91; 95% CI: 0.83-0.99; p=0.039), after adjusting for age, pre-operative PSA, pathologic stage, lymph node invasion, surgical margin status, and pathological Gleason score.
CONCLUSIONS: In this single center study, an increased diagnosis of localized and less extensive high-grade prostate cancer was observed over the last two decades. High-risk patients selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high-risk prostate cancer among contemporary patients are needed.
Fossati N, Passoni NM, Moschini M, Gandaglia G, Larcher A, Freschi M, Guazzoni G, Sjoberg DD, Vickers AJ, Montorsi F, Briganti A. Are you the author?
Division of Oncology / Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy; Dept. of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Reference: BJU Int. 2015 Mar 17. Epub ahead of print.