Risk and timing of biochemical recurrence in pT3aN0/Nx prostate cancer with positive surgical margin - A multicenter study

BACKGROUND - Positive surgical margins (PSM) after radical prostatectomy have been shown to be associated with impaired outcome. In pT3pN0 patients with PSM either immediate radiotherapy or clinical and biological monitoring followed by salvage radiotherapy is recommended by the latest guidelines of the European Association of Urology.

METHODS - A retrospective, multicenter study of eight urological centers was conducted on 536 prostatectomy patients with pT3aN0/NxR1 tumors and no neoadjuvant/adjuvant therapy. A pathological re-review of all prostate specimens was performed. Association of clinical and pathological features with biochemical recurrence (BCR) was analyzed using univariate and multivariate analysis.

RESULTS - With 48months median follow-up, BCR occurred in 39.7%. Preoperative PSA value, performance of pelvic lymph node dissection and Gleason score were significantly associated with BCR. In multivariate analysis, Gleason score was the only independent prognostic factor (p<0.001) for BCR. Five-year BCR-free survival rates were 74%, 70%, 38%, and 51% with Gleason score 6, 3+4=7a, 4+3=7b, and 8-10, respectively.

CONCLUSIONS - In pT3aN0/NxR1 patients with no adjuvant/neoadjuvant treatment, Gleason Score permits independent prediction of the risk for BCR. These findings could help to estimate and discuss the individual risk for BCR with our patients on an individual basis.

Radiother Oncol. 2015 Jun 29. pii: S0167-8140(15)00314-X. doi: 10.1016/j.radonc.2015.06.021. [Epub ahead of print]

Karl A1, Buchner A2, Tympner C3, Kirchner T3, Ganswindt U4, Belka C4, Ganzer R5, Wieland W5, Eder F6, Hofstädter F6, Schilling D7, Sievert KD7, Stenzl A7, Scharpf M8, Fend F8, Vom Dorp F9, Rübben H9, Schmid KW10, Porres-Knoblauch D11, Heidenreich A11, Hangarter B12, Knüchel-Clarke R12, Rogenhofer M13, Wullich B13, Hartmann A14, Comploj E15, Pycha A15, Hanspeter E16, Pehrke D17, Sauter G18, Graefen M17, Gratzke C1, Stief C1, Wiegel T19, Haese A17.

1 Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany.
2 Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany. 3Ludwig-Maximilians-University, Dept. of Pathology, Munich, Germany.
4 Ludwig-Maximilians-University, Dept. of Radiation Oncology, Munich, Germany.
5 University Regensburg, Dept. of Urology, Germany.
6 University Regensburg, Dept. of Pathology, Germany.
7 University Tübingen, Dept. of Urology, Germany.
8 University Tübingen, Dept. of Pathology, Germany.
9 University Essen, Dept. of Urology, Germany.
10 University Essen, Dept. of Pathology, Germany.
11 University RWTH Aachen, Dept. of Urology, Germany.
12 University RWTH Aachen, Dept. of Pathology, Germany.
13 University Erlangen, Dept. of Urology, Germany.
14 University Erlangen, Dept. of Pathology, Germany.
15 Zentralkrankenhaus Bozen, Dept. of Urology, Bozen, Italy.
16 Zentralkrankenhaus Bozen, Dept. of Pathology, Bozen, Italy.
17 Martini-Klinik am UKE, Dept. of Urology, Hamburg-Eppendorf, Germany.
18 UKE, Dept. of Pathology, Hamburg-Eppendorf, Germany.
19 University Ulm, Dept. of Radiation Oncology, Germany.


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