Oncological and functional outcomes after radical prostatectomy for high or very high-risk prostate cancer - European validation of the current NCCN guideline

To validate the current NCCN-classification of very high-risk (VHR) patients and compare the pathological, functional and oncological outcomes between surgically treated high- (HR) and VHR patients.

We retrospectively analyzed 4041 patients stratified into high- or VHR who underwent RP between 1992-2016. Kaplan-Meier as well as multivariable logistic and Cox regression analyses compared outcomes between the two groups.

After RP, the rate of adverse pathological features was higher in 1369 VHR vs. 2672 HR patients. Functional outcomes were similar between both groups, with one-year continence and -potency rates of 81.0% and 43.6% in the VHR compared to 81.9% and 45.2% in the HR group (p= 0.7 and p=0.9). In a subset of 1835 patients who underwent RP between 1992-2011 (median follow-up 58.8 months [IQR: 36.5-84.6]), VHR patients had significantly worse five- and eight-year biochemical recurrence-free survival (BFS), metastatic progression- free survival (MP-FS), prostate cancer-specific mortality-free survival (PCSM-FS) and overall survival (OS) rates compared to HR patients.

Despite the relatively poor prognosis of HR PCa patients, RP provides favorable five- and eight-year MP-FS, PCSM-FS and OS rates. Relative to HR patients, their VHR counterparts harbor significantly worse pathological and oncological outcomes and more frequently require additional therapies. These observations validate the stratification between HR and VHR in European PCa patients. Interestingly, VHR patients treated with RP did not have worse functional outcome than their HR counterparts.

The Journal of urology. 2017 Feb 16 [Epub ahead of print]

Raisa S Pompe, Pierre I Karakiewicz, Zhe Tian, Philipp Mandel, Thomas Steuber, Thorsten Schlomm, Georg Salomon, Markus Graefen, Hartwig Huland, Derya Tilki

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: .