Subclassification of high-risk clinically organ-confined prostate cancer for early cancer-specific mortality after radical prostatectomy.

High-risk clinically localized prostate cancer is seen in a highly heterogeneous population with a wide variation of clinical aggressiveness and a novel subclassification for the better prediction of clinical outcomes is needed. The aim of this study is to validate a modified D'Amico risk criteria for substratification of high-risk prostate cancer with regard to the prediction of biochemical recurrence, clinical progression-free survival or prostate cancer-specific mortality after radical prostatectomy.

We conducted a retrospective multicenter cohort study including 461 clinically organ-confined (cT1-2), D'Amico high-risk prostate cancer patients who underwent radical prostatectomy with pelvic lymph node dissection. The modified criteria subclassified D'Amico high-risk patients into high-risk (n = 189, single high-risk parameter and two low-risk parameters) and very high-risk (n = 272, at least one more intermediate or high-risk parameter in addition to the qualifying high-risk parameter) groups. Biochemical recurrence-free survival, clinical progression-free survival, prostate cancer-specific mortality and overall survival were analyzed.

The very high-risk group, compared with high-risk group, had significantly poorer biochemical recurrence (5- and 10-year biochemical recurrence-free rates: 52.8 vs 73.9% and 42.1 vs 61.7%, respectively, P < 0.0001), clinical progression-free survival (5- and 10-year survivals: 91.8 vs 98.2% and 80.5 vs 98.2%, respectively, P = 0.0013) and prostate cancer-specific mortality (5- and 10-year mortalities: 2.5 vs 0.0% and 6.7 vs 0.0%, respectively, P = 0.0124).

D'Amico high-risk patients can achieve very favorable outcomes unless they are classified as very high risk. Our novel subclassification method is very simple and useful for better patient counseling and decision-making in the pretreatment setting.

Japanese journal of clinical oncology. 2016 May 20 [Epub ahead of print]

Takashi Kobayashi, Takahiro Kimura, Chunwoo Lee, Takahiro Inoue, Naoki Terada, Yuka Kono, Tomomi Kamba, Choung-Soo Kim, Shin Egawa, Osamu Ogawa

Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea., Department of Urology, Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan .

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